Why Trinity, Anthem execs say payer-provider negotiations don't need to get heated

While market pressures have often left payers and providers at odds in contract negotiations, leaders at Trinity Health and Anthem Blue Cross said that things don't always have to be this way.

The two announced Thursday that they had reached an agreement to extend their network agreement for multiple years. One of the key factors underpinning the relationship is a shared push for value-based care as well as advancing data sharing and analytics.

The two will integrate Epic's Payer Platform into their operations, which will allow for easier data flow and approval processes embedded directly in the provider's workspace. The platform's Clinical Data Exchange program eases administrative tasks to allow providers additional time with patients.

"We expect that to improve and reduce delays in delivering care, and unnecessary administrative costs that we can avoid through technology," Stuart Kilpinen, senior vice president for payer strategy and product development at Trinity Health, told Fierce Healthcare.

In addition to working to share data more effectively, the two plan to build on an existing foundation in value-based care with Trinity adopting Anthem's methodology, which will allow for greater alignment around tying payments to better outcomes.

Jordan Vidor, vice president of networks at Anthem, told Fierce Healthcare that the value-based care partnership includes both commercial coverage and Medicare Advantage. The contract also extends across six states: California, Connecticut, Georgia, Indiana, New York and Ohio.

"Not only does it recognize the value that we deliver for our patients and the quality we deliver for our patients, but it rewards us to continue to improve that," Kilpinen said. "And that's important."

Over the past year, as providers feel the lingering sting of the COVID-19 pandemic and the challenges in labor, cost and patient acuity that it brought to bear, multiple payer-provider contract negotiations have gone contentious — and public.

Anthem, for example, was embroiled in heated contract negotiations with Bon Secours Mercy Health as well as startup provider Carbon Health. A similar dispute between UnitedHealthcare and Mount Sinai emerged earlier this month.

There have also been multiple cases of providers ending their network arrangements with payers in Medicare Advantage over what they say are low payouts.

But both Kilpinen and Vidor said that the negotiation process doesn't need to look like this. Kilpinen said that it boils down to both parties having a recognition and appreciation for the challenges facing the other. Anthem and Trinity came to the table with that understanding, he said, along with a willingness to collaborate and solve problems together.

"Health plan-hospital, payer-provider negotiations don't have to be what they've always been," Vidor said. "I think this renewal with Trinity, is as good of an example as you can find where the parties actually listen to one another about not just the problems at hand, but the corporate objectives and the business goals for how to improve the quality and the efficiency of care delivered over the long haul."