When should payers & providers affiliate? 4 experts weigh in

With outside players sliding into the healthcare space, hospitals and health systems must figure out how to strategically align themselves.

At Becker's Hospital Review 7th Annual CEO + CFO Roundtable in Chicago, Nov. 12-14, an expert panel shared their experiences with payer and provider affiliations. The panel featured:

• Kurt Anderson, senior vice president and general manager of payment integrity solutions at Change Healthcare
• Jeffrey Le Benger, MD, chairman and CEO of Summit Medical Group in Berkeley Heights, N.J.
• DeWayne Wilson, CFO of Texas Health Aetna
• Britt Tabor, CPA, FACHE, executive vice president and CFO/treasurer of Erlanger Health System in Chattanooga, Tenn.

Here are each of the panelists' biggest takeaways:

“You have to look at how far along you are on the continuum of value-based technology,” said Mr. Wilson. “For example, depending on the size for your network, you could make a Medicare advantage play. I think you can be the master of your own zip code versus a commercial health plan. Having the payer component offers another revenue stream to diversify the approach to deliver healthcare.”

“It's important to look where you are,” said Dr. Le Benger. “There is pay-to-play or going after the premium dollar. So, you have to see the size of your organization and what the capital restraint is. To play in the field of population health, there is a huge cost barrier for that. To be able to take risks you have to have your data analytics backlogged, you have to look at the type of risk you want to take on. Usually you start by partnering with the payers and move into risk with them.”

“From Erlanger, we decided some time ago being in the insurance business was not our core competency," said Mr. Tabor. “So, we have had a long strategy of partnering. And it's not just one insurance provider we partnered with. If you look at the market and what employees are demanding, they are demanding difference. So, for example, Cigna, for us, had a strong narrow network. What's different about it, is that when Cigna is selling it to employers, Erlanger is right there with them. Since we do have a comprehensive offering of services, we are there to help sell the product. On the other side, we have Blue Cross. They have a two-system offering.”

“You may think, how do you collaborate in a fee-for-service space?” said Mr. Anderson. “Administratively, we work in common technologies that we see in the marketplace. There is a technical collaboration that happens within the market. What we see more and more of is being asked to be the third-party, impartial participant to help a payer and a provider establish a policy or a practice. In Phoenix, we partnered with Blue Cross Arizona and also with a local provider community to set up a defined accountable care organization.”

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