As payers and providers increase their collaboration to launch more value-based care programs, they must establish strong partnerships to ensure the relationships, reported Health Data Management.
"In a climate where the costs of healthcare are skyrocketing and providing high-value healthcare has become an imperative, both payers and providers have important roles to play," Paul Taylor, an internal medicine physician at Mercy Health, wrote in the article. Payers' chief responsibility in the relationship is developing outcomes-based payment models, he added.
Additionally, Taylor shared three steps payers can take to enhance providers' performance in value-based programs:
1. Reimburse for the end-to-end population health management workflow
To help providers embrace value-based payments, insurers can design programs with comprehensive incentives for population health management (PHM). Instead of focusing on only closing care gaps or reducing utilization rates, for example, payers should reimburse for the entire workflow so that providers are more willing to invest in the sometimes pricey resources needed to implement value-based programs.
"If payers coordinate their efforts to ensure that, together, their programs reimburse for more PHM workflows and outcomes, providers will have the critical reimbursement mass they need to invest in value-based care," Taylor said.
2. Share as much data as possible
Since payers have a vast amount of data enabling them to create risk models, perform financial analytics and better understand which members need what services, sharing that information is tremendously valuable for providers. For example, Aetna shares its data with its provider partners, believing that the information helps doctors and hospitals do a better job at a lower cost, FierceHealthPayer previously reported. But insurers shouldn't just dump data on providers and expect them to understand it; instead, they should assist in analyzing and drawing specific conclusions.
On the flip side, providers that are collecting their own data, which is often richer in patient care history than payers' claims data, should share this information with insurers. Then, payers and providers can both use a more complete set of data to improve quality of care.
3. Collaborate at the organization level
Instead of working at the practice level, insurers should collaborate at the organization level. Under that theory, value-based programs will move faster when payers work with physician groups like independent practice associations and physician-hospital organizations. These physician organizations can represent the voice of the physician community to the payers and also provide technology education and consulting on best practices with their physician members. The organization leaders can work with payers to educate and consult with their doctors for technology best practices.
To learn more:
- read the Health Data Management article