Key payer issues in 2018 — 4 thoughts

The transition and adoption of the value-based care model, and implementing and fully utilizing new technology are some of the biggest issues challenging payers this year.

Several executives spoke about key issues that have affected payers in 2018 during a Sept. 19 panel at the Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference, which took place Sept. 19-22 in Chicago. Panelists included Andrei Gonzales, MD, assistant vice president of value-based reimbursement product management at Change Healthcare; Stephanie Pierce, director of operations at Priority Advantage; and Michael Patti, principal at Baker Tilly Virchow Krause.

Here are four takeaways from the panelists on key payer issues in 2018:

1. "We have to get to know our members better. We have to understand how they are accessing care [and] why they were doing that," Ms. Pierce said. "We have to understand, especially for Medicare Advantage [beneficiaries], why is that beneficiary only seeing their primary care provider once a year; why aren't they seeing their specialist? We all need to get to know our members better."

2. "It comes down to coordination of care," Dr. Gonzales said. "You need to take care of the patient in front of you, but you also need to be thinking about the patient who's not there. … It's that sort of process thinking [you need] to really understand how to best coordinate care for the patient in front of you and [the type of care] for all those patients you're responsible for."

3. "If the member is the new payer, maybe the payer's role is to help them navigate the complicated [healthcare] system," Mr. Patti said.

4. "I think the idea of having a common portal among payers is pretty challenging from a lot of perspectives. Health plans really view what they do as proprietary … and that discourages collaboration. One area that we try to promote and that we are getting more interest in from our health plan customers, [however], is the idea of standardization," Dr. Gonzales said, which he said can apply on the provider side as well.

"Standardizing the rules … [means] there are fewer methodologies that you have to comply with and understand — so a provider can can provide the best care possible to their patient instead of worrying about which model is best for the patient," he said. "That sort of standardization, I think, is the most important thing and the thing that still really eludes the market."

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