Traditionally, payers and healthcare providers have been portrayed as having conflicting goals. However, as the healthcare industry evolves and implements outcomes-based payment models, health insurers and providers are collaborating more than ever before.
At the Becker's 5th Annual CEO + CFO Roundtable on Nov. 8, four healthcare industry executives from the payer and provider sides discussed ways they are collaborating and key considerations for those partnerships.
Here are four key points shared by the panelists.
1. Establish pillars of success. Before collaborating with a payer, Mike Kasper, CEO of DuPage Medical Group in Downers Grove, Ill., says it must be clear the partnership will lead to improved patient outcomes, create value for both parties and have long-term capabilities. Mr. Kasper discussed how these pillars were met with a partnership DuPage Medical Group entered into with Blue Cross and Blue Shield of Illinois that allows the medical group to better participate in value-based care initiatives.
2. Compare missions. When considering a partnership with a payer, it is important to "make sure the missions match," according to J. Britton Tabor, executive vice president, treasurer and CFO of Chattanooga, Tenn.-based Erlanger Health System. Mr. Tabor said the most recent joint ventures and affiliations Erlanger has entered into have been successful, which is due, in part, to them being a good match.
3. Remain flexible. Although there are key guidelines of success for provider-payer partnerships, such as the ones mentioned by Mr. Kasper and Mr. Tabor, organizations must be flexible in their approach to these collaborations. "What we look for depends on what we're trying to put together," said H. Scott Sarran, MD, CMO of government programs at Chicago-based Health Care Service Corp. "We find very few provider partners that are capable of creating partnerships along all product families."
4. Aim for more collaboration. Although payers and providers are finding ways to work together, there is room for improvement, according to Russ Thomas, CEO of Availity, a healthcare revenue cycle and business solutions provider. Mr. Russ said he is seeing a much greater willingness now among payers and providers to collaborate than in the past. "Yet, we're still sitting here today with a lot less collaboration than we would like to see," he said.
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