Combine strengths of payers, providers for accountable care success

With healthcare reform and new payment models drastically changing the care delivery system, collaboration between payers and providers is essential for success. That was the message shared in a session Wednesday at the World Congress 9th Annual Leadership Summit on Medicare in Washington, D.C.

"Regardless of whether it's Medicare, Medicaid or commercial insurance, we have to play to each other's strengths," said Eric J. Berman, D.O., regional chief medical officer at health plan AmeriHealth Caritas Pennsylvania.

Providers' strengths include acute care delivery, specialty care and technology. Payers' strengths consist of managing risk, population management, and member outreach and education, Berman said. 

A collaborative approach that builds on the individual strengths of providers and payers can help improve patient experience and population health and reduce costs.

And with increased focus on the triple aim, hospitals, physicians, payers and the government need to stop the tug of war over who is driving the healthcare system. "What has to drive the system is our outcomes," Berman said.

However, getting all components of the continuum of care to work together for better outcomes can prove challenging, another panelist at the event said.

That was the case at OSF Healthcare System in Illinois, whose Pioneer accountable care organization encompasses six acute care hospitals, 707 physicians, 51 level three patient-centered medical homes (PCHM), 216 nurse practitioners, as well as home care and hospice.

"We have the whole spectrum of care but even within our delivery system … we didn't all play well together, said Tara Canty, OSF chief operating officer of accountable care and senior vice president of government relations.

"When you're part of an integrated delivery system, normally the hospital rules," she said, noting that adopting the Pioneer ACO model has changed that dynamic.

OSF is finding success with the ACO model, but as Berman pointed out, it doesn't matter what acronym healthcare organizations use. Whether ACO or PCMH, a collaborative approach will create a win for providers, patients and insurers if it's about aligning the incentives to promote high-quality outcomes, better population health and lower costs.

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