Value-Based Payment Collaboration and the Payer-Provider Relationship

As health plans continue the transition towards value-based payment models, the payer-provider relationship only continues to evolve. More than ever, it’s become increasingly important to encourage providers to participate in cost-savings. For providers, the desire to participate is there, but past tension between the two groups has fueled hesitation. So how can you have better engagement your providers and encourage collaboration? Let’s explore three key components of succeeding within the modern payer-provider relationship.

Alignment

Healthcare systems nationwide have been exploring value-based care arrangements, but what has often held providers back from embracing value-based care is a fundamental misalignment between payers and providers. To address this misalignment, work with experts from outside of your organization to assess your market and provide data. This lays the foundation for discussions around value-based care, which ultimately starts everyone off on the same foot. The incentives and goals of both payers and providers should be well-defined prior to contracting in order to facilitate the development of unified objectives. You want to make it clear what you’re both hoping to accomplish so that you’re able to draw out incentives and designate the appropriate metrics and measurements to gauge success.

Clarity

Once your goals are laid out and your motivations are aligned, you can begin to bring clarity to the specific metrics that will measure provider success, both clinically and financially. The best metrics to hone in on in the initial stages are the ones where providers have data that clearly shows improvement. From there, branch out into other areas of care where improvement or course correction is necessary to reduce gaps in care. 

Beyond reporting, quality measures need to be supported by the data necessary to identify care gaps and foster improvement. Once you agree on which measures accurately reflect your shared goals, be sure to have solutions in place with the measure reporting and analytics capabilities needed to determine if those goals are being met properly.

Transparency

In the payer-provider relationship, both parties accumulate large quantities of data that can be useful to one another when it comes to adopting a holistic patient approach. Payers have access to the claims data, while providers possess the clinical data. Payers see all claims presented by a plan member, while providers may only see the specific claims they’ve generated. By working with each other and allowing for a free exchange of data and information, payers can offer providers a fuller picture of where there may be duplicate costs. 

To do so, it’s essential to have performance tracking and analytics solutions that are easily accessible to your providers. When providers can see how they are performing, they feel driven to hit targets more consistently while also having the peace of mind that they’ll be fairly compensated within the terms of the contract. 

Conclusion

Collaboration and an improved payer-provider relationship are the keys to successful value-based payment arrangements. Mutual understanding of each other’s goals, clarity of terms and measurements, and a transparent analytics program accessible to both parties can help bridge the gap that exists within the payer-provider relationship.