3 ways to harness data in payer and provider collaborations

Payers and providers are continuously looking for ways to join forces in a healthcare ecosystem dependent on reaching patient-centric and value-based goals.

As a result, data analytics plays an increasingly prominent role in helping providers and health insurers exceed quality metrics while keeping costs down. Bruce Carver, associate vice president of payer services at MedeAnalytics, told Becker’s Hospital Review greater opportunities exist between payers and providers to share best practices and incorporate data analytics to enhance value-based care.

Here are three ways for payers and providers to better leverage data analytics.

1.  Exchange clinical and claims data. Mr. Carver says payers maintain a significant amount of claims data that creates a holistic view of the patient, while providers typically have discrete clinical data information. He says the industry's gradual shift to value-based care requires payers and providers to collaborate in a very different way than they were previously able to. Due to the shift, Mr. Carver says it's imperative collaboration exists "between the provider sharing that clinical data with the payer. And [conversely], that the payer works with a provider to put the right incentives and validation in place for them to be successful in their value-based care arrangement."

2. Mend trust between payers and providers. In terms of payers' and providers' ultimate goals, Mr. Carver says if a "payer is going to work hard to identify patient populations, their gaps in care and then engage with higher risk populations — the healthcare payer needs to align [its] incentives [with] the provider so they're setting up systems and processes within the practice to accomplish that same goal." He says payers may need to work extra hard to understand the providers' processes within their practice to improve collaboration and access to information.

3.  Get on a shared data platform or capability. Mr. Carver says data analytics plays a key role in identifying and improving gaps in care within a patient population. Therefore, he says payers and providers should use "a shared platform or capability where the input of clinical data and the claims data are integrated to identify gaps in care in real time." He says the integration between the two entities helps identify what care is required, which can curb readmissions and have a greater effect on medical costs and outcomes.  

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