New models of collaboration emerge between payers and providers

Market forces, including the shift to a value-based payment model, have altered the dynamic between payers and providers of healthcare, according to a brief on The Chartis Forum.

The result is new models of collaboration between the two groups that once had an often adversarial relationship, according to the brief's authors. Models vary in their level of organizational and financial integration, but include the following common partnerships:

  • Loosely integrated contractual network arrangements, such as Aetna Whole Health, which has partnered with providers in select markets around the country to create insurance products built on narrow and tiered provider networks.
  • Contractual network arrangements with equity investment. An example is Community Advantage Plan, a partnership whereby Cooper University in 2013 acquired a 20 percent state in AmeriHealth in New Jersey to offer co-branded products on insurance exchanges.
  • New joint ventures, such as the partnership between Aetna and Inova Health System to create Innovation Health, a 50/50 joint venture health insurance company. That new health insurance plan, offered to consumers and businesses in Northern Virginia, is one of the lowest-priced plans in that market with more than 170,000 members in less than two years, Harold M. Paz, M.D., Aetna's chief medical officer, wrote in a recent contributed piece for FierceHealthPayer.  

"As providers and payers consider the value of co-developing product offerings or entering into a joint venture, executives should reflect on lessons learned from the initial round of payer-provider partnerships," the authors wrote. Those lessons include aligning the strategic vision and performance expectations for the partnership, the ability to create a compelling, differentiated value proposition, defining the operating requirements and what each party brings to the table, accounting for the impact on existing relationships and lines of business, and demonstrating a shared commitment to the collaboration.

The most fully integrated model, such as provider-owned health plans, are still rare, but there are a growing number being made available on the health insurance marketplaces created by the Affordable Care Act, according to a recent report.

To learn more:
- read the brief

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