As payers and providers transition to value-based care, many providers feel like they have a foot in two boats. Fee-for-service care is all about volume, while value-based care rewards quality and outcomes. Information sharing between payers and providers is essential for successful value-based care. Yet, this is exactly where significant friction exists today, making the transition to value even more challenging.
This content is sponsored by InterSystems
On April 2, InterSystems hosted a workshop at Becker's Hospital Review's 10th Annual Meeting in Chicago to explore how payers and providers can share information and collaborate more effectively. During the workshop, Lynda Rowe, InterSystems' Senior Advisor for value-based markets, discussed barriers to payer and provider alignment and shared examples of healthcare organizations that are successfully collaborating today.
Healthcare's digital transformation
Decentralized health systems, information intensity and the shift to value-based care are major factors driving the digital transformation in healthcare. Each year, for example, the typical senior patient in the United States visits seven providers across four practices, according to Ms. Rowe. In this environment, it is difficult for providers to have a clear and comprehensive view of their patients.
Additionally, Ms. Rowe said healthcare data is growing 60 percent faster than the amount of data in other industries. "While rich patient information abounds, human cognitive capacity to process this information is limited. The typical person can only process around five facts when making a decision. Healthcare providers simply can't synthesize all the information that's available."
As organizations shift to value-based care, the ability to move and share data across care settings is essential. In a recent survey conducted by the Healthcare Financial Management Association[i], respondents indicated that interoperability is the most important capability for value-based care.
Removing obstacles to payer and provider alignment
Eliminating friction between payers and providers begins by creating an environment of trust. Both parties must have conversations about where they are trying to go and what the journey looks like. Once trust exists, payers and providers can begin discussing shared resources and making the best decisions for patients and members.
When payers and providers share data in transparent ways, it is possible to unify information and create a single view of a patient. This enables both groups to focus on use cases with shared benefit. Common objectives are to lower costs, improve quality and enhance patient satisfaction.
Payer-provider collaboration in action
Several leading healthcare organizations are participating in innovative partnerships that support value-based care:
- Premera Blue Cross. This payer has over two million members and 38,000 providers in Alaska and Washington state. It serves large employers including Starbucks, Boeing and Amazon. Premera Blue Cross partners with providers to address the entire continuum of care. Its new "Peak Care" offering is based on an alliance with MultiCare, an integrated delivery network partner. Peak Care offers integrated services to help patients navigate the network and access the right providers.
- Manifest MedEx. This California-based nonprofit health information network was founded by payers. The information exchange covers 15 million individuals and is expected to grow to 25 million. "Manifest MedEx sees itself as a utility that frees health information from silos and unblocks healthcare. This allows both payers and providers to work together effectively," explained Ms. Rowe.
In the world of value-based care, traditional roles are changing. Providers are taking on financial risks and payers are getting directly involved with care delivery. "Historically, the provider and payer worlds have been very different, but now we often talk about 'payviders.' To smooth the journey to value-based care, we need more collaboration, coordination and data sharing between both payers and providers," Ms. Rowe said.
- [i] Source: HFMA Executive Survey http://www.hfma.org/ValueBasedPaymentReadiness/