Payer-Provider Collaboration Should be Considered in Healthcare Practices

Author: PrognoCIS Marketing | December 17th, 2014 | Payer-Provider Collaboration Should be Considered in Healthcare Practices

Lately, healthcare has been emphasizing payer-provider collaboration. Payers and providers both have a common goal of improving patient outcomes and optimizing finances. By working together, they can considerably reduce the time and resources needed to reach that goal, as well as streamline the system and work on establishing a value-based model.

Mason Beard of Wellcentive, Inc., affirms the necessity for cooperation between payers and providers, “this partnership…is the way that’s going to make a sustainable healthcare system.” He states that payers must engage providers in their quality measures to ensure they understand, while providers should share clinical data. Providers have access to important information regarding their patients’ medical history, which, if shared with payers, will enable better coordination and maintain a patient-centered focus.

A September 2012 study in Health Affairs examined a collaborative arrangement established by Aetna and an IPA in Maine, known as NovaHealth. Their goal in this venture was to improve patient outcomes for a group of roughly 750 Medicare Advantage members. The two organizations work together to generate reports on five quality metrics, assessing office visits, chronic disease management, care coordination, and hospital readmissions. A case manager from Aetna and several care coordinators from NovaHealth were assigned to ensure patient needs were met and assess the care provided. The study emphasized that case management resources were key to the success of the collaboration, as was frequent communication between both organizations.

Results showed 45% fewer hospital admissions and 50% fewer hospital days per 1,000 patients. Compared to the unmanaged Medicare populations across Maine, there were 56% fewer readmissions. NovaHealth reported per member per month costs for Aetna Medicare Advantage members to be 16.5% to 33% lower than other members. Overall, the arrangement appears to have been successful, suggesting that other such payer-provider collaborations involving healthcare organizations should be considered. These organizations represent a network of physicians and directly incorporate their approach and mentality; working with them will allow for smoother collaboration and, hopefully, produce similar results.

Author: Apoorva Anupindi