Quest for data drives new provider-payer partnerships

As the healthcare industry evolves, it appears payers hold the key to sustained success in the form of patient data, prompting mutually beneficial partnerships with providers, according to Marketplace.

The industry is undergoing significant changes following UnitedHealth's recent announcement that it will pull out of Affordable Care Act exchanges in all but a handful of states. Days later, Anthem announced a partnership with Aurora Health System in Wisconsin that focuses on keeping patients healthy by steering them to a select group of providers.

These kinds of partnerships are rooted in the quest for better data that will help drive down healthcare costs. Until now, that data has been largely inaccessible to providers, but information about why a patient didn't fill a prescription can be integral to understanding the social and economic factors that impact care, John Foley, senior vice president of Wisconsin hospital system Aurora Health Care and president of the new joint venture with Anthem, told Marketplace.

This quest for data has prompted an increasing number of health systems to offer their own insurance plans. In 2016, nearly 60 percent of new entrants into Medicare Advantage were provider-sponsored plans. However, in an effort to head off potential competition, insurance companies are pitching themselves as the ideal partner in this new business venture, a notable shift from their past relationship.  

"They are used to having nose-to-nose confrontation with hospitals," healthcare actuary John Bertko told Marketplace. "To move to a thing where it's collaborative is really a change in direction."

To learn more:
- read the Marketplace article

Related Articles:
Anthem taps Wisconsin health system for new payer-provider venture
CEO Stephen Hemsley: UnitedHealth will exit all but a few Affordable Care Act exchanges
Provider-led health plans: The future of healthcare reform?
More provider-sponsored health plans in the Medicare Advantage market

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