Collaboration & Communication: The Development of Payer-Provider Partnerships

In 2017, one of the biggest developments in the healthcare industry was the change in population health management. Through the use of big data, we saw the integration of many different electronic health records (EHR) with the goal of better understanding a patient’s health and the costs associated with their care. Additionally, we started to see collaborative partnerships develop between payers and providers, each previously operating in separate channels.

Payers and providers each benefit from strategic partnerships. As they continue to come together in 2018, payers will likely see reduced costs, and providers will be able to provide better quality of care by identifying and potentially slowing the progression of chronic illness, such as diabetes and heart disease. In light of the switch from fee-for-service to value-based reimbursement models, providing the best care possible is especially important for providers.

Approximately 45% of the population has at least one chronic illness, such as diabetes, heart disease or cancer that may lead to deteriorating outcomes. We know that the inability to identify individuals with chronic disease states may lead to unnecessary emergency room visits, more frequent visits to a number of different providers, and possibly an increase in the number of hospital admissions/readmissions. All of these factors drive up healthcare costs.

In taking a look at data available to them, both payers and providers can analyze population health data to identify high-risk/high-cost patients. An even deeper look at the data may reveal overlaps in care, as well as gaps in care. Payers and providers can then work together to develop preventive care offerings and establish appropriate care plans.

Another factor influencing payer and provider relationships is the presence of HDHPs (High Deductible Health Plans). Now more than ever, patients are interested in pricing transparency for the services related to their care. They often inquire about costs before procedures or office visits with the deductible in mind. Thus, engaging patients in their healthcare provides a level of proactivity and better outcomes. Payers and providers are working together to provide patients with accurate information—the provider should be knowledgeable of the cost to the health plan and patient, and the payer should be able to provide patients with cost projections for  the medications/tests a patient may be prescribed.

While not long ago payers and providers operated very separately, in 2018 we will continue to see an increased number of Payer-Provider partnerships. We’ll also see the optimization of population health data systems from which payers and providers can glean the insight needed to provide better care at a lower cost. Patients will also continue to be invested in their healthcare decisions, especially those with HDHPs.  Collaboration and communication will be the key ingredients which garner positive results in 2018.

Catholic Benefits Trust