Leveraging payer-provider partnerships to enhance the health consumer experience

The healthcare system in the United States is arguably one of the largest collaborations we all actively participate in.

Friso van Reesema, VP of Payer Strategy at CipherHealth, has over 15 years of experience crafting effective collaborations and partnerships between payers and providers. In this article, van Reesema explores what it will take for providers, payers and patients to achieve effective teamwork.

As a volunteer for the Stamford Hospital’s Patient Family Advisory Committee, van Reesema often posed himself the following question: Who is standing up for the combined, mutual interests of patients, families, and communities? How can teams stretch beyond the walls of the hospital, health plan, school, and community organization to reach people in the community, with their family and at home? 

The Importance of Collaboration Between Providers and Payers

Provider-payer partnerships enable a more collaborative care team that can address the diverse needs of the patient, their family, caregivers, and the community. In some cases, providers and payers must naturally work as a team due to legal and financial ties. In other cases, payers align financial incentives with providers on quality, outcomes, and satisfaction measures to improve the patient experience. Some payer and provider partnerships may find it difficult to collaborate across the entire continuum of care. However, there are many benefits to engaging the health consumer through multi-channeled communication throughout the patient journey to lighten the burden for both the provider and payer.

Depending on how providers and payers align their communications with healthcare consumers, the experience may still be disjointed. Today's consumers expect care to be coordinated across providers, payers, pharmacists, and other third-party entities. Although patients expect personalized coordination, it isn’t always a reality. When payer-partnerships align, it can have immense benefits for everyone involved. This is the case with Sentara Healthcare, a provider, and Optima Health, a payer. 

Seeing Success for Providers, Payers, and Patients with Effective Teamwork

Sentara Health System and its fully-owned health plan, Optima Health, collaborate on preventive screenings with a patient-centered approach. One example of their partnership includes sharing data on individuals in their community who are at-risk for colorectal cancer. After the Sentara and Optima teams identify at-risk patients through predictive modeling of shared claims and clinical data, a communication plan is developed to engage at-risk members, offer an in-home screening, and, if necessary, escalate identified issues for further intervention. 

The coordinated communication from Sentara Medical Group primary care providers and their Optima Medical Directors yields higher engagement rates, adding to the screened population 20% more individuals who had previously been ignoring their recommended screening. This example of payer and provider collaboration detected colon cancer in 5 individuals at an earlier stage than if the program had not been implemented. Dr. Tom Lundquist, Chief Medical Officer of Sentara Health Plan, described the partnership as “an essential way to support our members, their families and our caregiver partners by using claims data, smart algorithms and then technology-assisted outreach, communication and follow-up. We accomplish more together.”

There are many forms of payer-provider partnerships worth exploring for valuable patient-centered outcomes. Some examples of a few successful partnerships worth noting are:

  • Geisinger joined forces with 6 hospitals and 270 physicians to share cost savings offering lower premiums for members.
  • The Moffit Cancer Center and United Healthcare created bundles to identify best practices and reduce variation and cost of care through radiation and surgery bundles. This helps health consumers and families shop for the best value for their specific condition.
  • The HealthShare Exchange (HSX) of Southeastern Pennsylvania, allows providers and payers to coordinate care based on encounters and claims information for the benefit of the healthcare consumer. This effort reduces errors, duplication of efforts, and negative time spent in the healthcare system.

The Future for the Payer-Provider Partnership

These examples are changing the health consumer experience by improving the coordination of communications, quality care, competitive pricing, and convenient access. Teamwork is increasingly required in healthcare, and the partnership efforts often remain in their early stages as IT systems and innovative, patient-centered technologies are slowly infused into our workflows and patient flows.

What kind of teams are you on to improve the health consumer experience? Are you offering your partners in care a spot on the  team with information to help communicate and coordinate care? How can we channel our efforts and key learnings from our families, patients, and communities to enhance outreach and support health consumers? 

Advocating for healthcare partnerships improves the healthcare experience for all of us and moves our system to a truly consumer-focused industry; one that supports the health consumer, family and community.

For more information on how payer-provider partnerships are changing, email us at managedcare@cipherhealth.com

Friso van Reesema

Friso van Reesema brings over 15 years of experience to his current role as VP of Business Development for Payers at CipherHealth. In addition to the health plan perspective, Friso volunteers at Stamford Hospital in Connecticut, a Planetree re-designated site, on their Patient Family Advisory Committee (PFAC) and the Compassionate Interactions Committee. Friso earned his Master of Public Health degree from Johns Hopkins School of Public Health, studied Cultural Anthropology at Leiden University in The Netherlands, as well as earning a Masters in Business Administration from an Erasmus program in Rotterdam and Madrid.






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