How Payer-Provider Collaboration Promotes Value-Based Success

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The health delivery system was impacted by COVID-19 in ways that led to the transformation of healthcare systems to deliver better value to patients. The challenges encountered validated the key features of value-based healthcare and proved that collaboration between payers and providers enables them to build and achieve high-value outcomes holistically.

What is the Value-Based Care Model

The foundation of value-based care centers on providing better care for individuals, improving health management strategies, and reducing healthcare costs. Providers are paid based on the health outcomes of their patients and the quality of services delivered. In a traditional fee-for-service model, providers are paid separately for each medical service they provide. The difference between the two isn't the quality of care that can be provided. It's the combination of how patient care is managed and how providers are paid that fosters improvements in health care and savings across the board.

3 Keys to Payer-Provider Partnerships

Trust is an essential first step in building payer-provider collaboration. Building trust can be challenging if there is an existing fractured relationship, which is often the case. Differences can be overcome by aligning the most critical issues as soon as possible. This can't happen without communication. It's one of the first steps to building trust.

Communication needs to be a two-way street. When both sides communicate with transparency and no hidden agendas, it opens the door to finding common goals. Advances in technology have enabled and simplified communication across various systems and platforms. Investing in these technologies allows both parties to communicate regularly and share data seamlessly. While communication helps payers and providers to focus on each other's goals and needs, they also need to consider the patients.

A focus on the patient factors into the success of value-based care. Patient care management is improved when payers and providers can share data. It also fosters trust between the patient and the health care provider through transparency of medical records, patient billing, and claims access.

Obstacles in the Transition to Value Based-Care

A fragmented reimbursement system hampers the transition to value-based care. Change is difficult when processes have been in place for years, and it's the only process some payers and providers know. Those who remain grounded in the fee-for-service model are resistant to sharing transparent data. Small and rural practices often don't have the funding for new technologies and staff training to make the transition to value-based care. Fears about revenue stability and sustainability when adjusting to a value-based payment system are front of mind for these small practices.

Value-Based Care is an Ongoing Process

Creating a value-based care environment isn't as simple as implementing new software. It's an investment over time of continued learning and improvement. Stakeholders need to regularly analyze outcome data, learn from leading practices, implement service improvements, and measure how they contribute to achieving value for patients and the healthcare system.

A Solution that Does All the Work

Payers and providers are both strapped for time and resources. Payspan’s Quality Incentive Communications System (QICS) can help promote collaboration between payers and providers. Payers transmit communications over the network to engage in a two-way exchange of information about patient members with providers to close care gaps, implement quality measures, and award incentives. Download our Value-Based Care eBook for more information.