Health plans can bring valuable insight to clinical teams—but are providers open to such discussions?
Deloitte surveyed 300 providers across different clinical roles and specialties and found that two-thirds are willing to use solutions offered by payers to address care concerns. However, some of those surveyed remain skeptical about how useful such collaboration can be, as working with insurers is typically associated with more paperwork and rejected claims.
Still, the findings are a sign that these long-standing silos are breaking down, Matthew Kaye, managing director at Monitor Deloitte and one of the report’s authors, told FierceHealthcare. Payers have been “fighting an uphill battle for years” to facilitate these conversations.
“I think that the fact that providers are more open to working with and receiving solutions from health plans is a very promising sign, just generally for the industry,” Kaye said. “It’s an acknowledgment that our healthcare system is so challenged and that two heads are better than one.”
For health plans looking to collaborate more fully with providers, a good starting point is to pitch solutions in areas where payers can fill a clear need, such as data collection, analytics and care coordination, according to the survey.
Primary care providers, in particular, welcomed assistance from health plans in improving coordination, the survey found. Overall, 92% said providing insight into test results is valuable, 90% said a broader look at medication history would be beneficial and 89% said health plans could ensure that PCPs see notes and information from specialists.
The surveyed providers also flagged partnership in chronic care management, such as securing rides to appointments and tracking medication adherence, as crucial starting points.
Kaye said that payers should also come into conversations about collaboration knowing how providers perceive them and be prepared to confront those perceptions: “They need to be creative in finding different ways to drive adoption of these insights and solutions.”
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In addition, the survey highlighted several ways payers can incentivize providers to enter collaborative projects. For example, 22% said they’d “definitely” agree to meet certain quality or outcome goals in exchange for easing certain prior authorization requirements, and 18% they would “definitely” agree to a program that would put them as a preferred provider, leading to lower copays.
Undergirding all this potential collaboration is the industry’s move toward value-based care. Success in value-based arrangements requires payers and providers to work closely together and benchmark outcomes and spending. Value-based contracts could also serve as a crucial in for payers looking to collaborate more with the providers in their networks.
And there are ripple effects of this beyond value-based care, Kaye said: Interoperability and data-sharing is going mainstream even in fee-for-service care.
“Value-based care is a really good wind in the sails for data-sharing between these different players, and it’s a really good example to cite of how data-sharing can be effective,” Kaye said.