Payer-provider collaboration: Notable partnerships in 2016

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The quest to expand access to data in order to lower costs is a driving force behind many payer-provider partnerships.

Providers and payers continue to chip away at years of built-up distrust through new partnerships aimed at reducing healthcare costs, improving care and perhaps most importantly, sharing data.

Make no mistake; this often-fraught relationship has not made it over the hump entirely. Increasingly, however, both sides are showing signs of closing that trust gap by engaging in new collaborations of all shapes and sizes. In some cases, a driving force behind these partnerships is the quest to expand access to data that holds the key to lower costs.  

Below are a few of the key payer-provider collaborations that have emerged over the past year:

Pennsylvania systems take aim at health costs

In September, Geisinger Health Systems and St. Luke’s University Health Network announced a new partnership aimed at lowering premiums. Through the collaboration, six hospitals and 270 medical offices within the St. Luke’s system partnered with the Geisinger Health Plan, immediately adding the provider’s 10,000 employees to the plan.

The partnership is scheduled to launch on Jan. 1. Executives say it will drive down premiums by allowing the two organizations to share in any costs savings.

Partnership focuses on cancer care

A partnership between Moffitt Cancer Center in Florida and UnitedHealthcare established a new bundled payment designed to drive down the cost of cancer care.

For a three-year pilot project, the two organizations developed surgery and radiation therapy bundles focusing on early stage lung cancer. The goal behind the partnership is to reduce costs by incentivizing providers to reduce variation through evidence-based best practices.

Anthem, Aurora steer patients toward a narrow network

Earlier this year, Anthem joined forces with Aurora Health Care in Wisconsin to create the Wisconsin Collaborative Insurance Co.

The partnership offers a commercial health plan called Well Priority, which steers patients to high-quality providers within the state. The network includes physicians and hospitals within Aurora Health Care, as well as other systems throughout the state with high quality rankings. The two companies expect to drive down healthcare costs by engaging with patients to improve their overall health and using high-quality providers.

The new 50-50 venture was born out of a 2012 partnership in which Anthem offered incentives and penalties for Aurora physicians based on specific quality measures.

Innovation Health proves its worth

Aetna and Inova Health System in Northern Virginia solidified their partnership back in 2012 through the creation of Innovation Health Plans, a jointly owned plan that offered financial incentives for low-cost, high-quality care.

Four years later, executives have pointed to tangible benefits of the partnership, including a reduction in medical waste costs. The balanced approach has also improved the consumer experience and brought in 170,000 new members.

Harold Paz, M.D., Aetna’s chief medical officer, said one of the primary reasons he shifted his career from the provider side—at Penn State Hershey Medical Center—to the payer side was because he saw opportunities to join the two industries through collaboration.

Bright Health plans to leverage provider partnership

After Humana and UnitedHealth exited Colorado’s Affordable Care Act exchange earlier this year, insurance startup Bright Health saw an opportunity to fill the gaps left behind. The company is set to offer plans on the state's marketplace starting in 2017.

Utilizing its existing partnership with Centura Health System, Bright Health co-founder and President Kyle Rolfing told FierceHealthPayer the insurer plans to leverage that partnership to maintain cost efficiency and high-quality care and invest in technology that allows the two organizations to share data.  

"With our partnership with a health system, we’re able to invest in technology in a different way by building a data hub where we share data between us," he said.