This website uses a variety of cookies, which you consent to if you continue to use this site. GlobalHealth is an Oklahoma-based health maintenance organization (HMO) that initially began with a network of primary care services and has expanded over the years while remaining provider-centric, Thompson said. You can read our privacy policy for details about how these cookies are used, and to grant or withdraw your consent for certain types of cookies. The payer imperative is to find the sweet spot where investment in prevention and high-quality care balances out financially with the cost avoided through better health and lower utilization of high cost services. 18 West - North Westmoreland St. While other payers have had a rise in premiums since the Affordable Care Act took effect, GlobalHealth has kept their costs down, saved on spending, and passed those savings forward to their consumers. As the healthcare industry continues to transition to value-based care (VBC) models, financial risk is shifting away from the payers and toward the providers. Healthcare industry payers are now moving aggressively toward value based care and reimbursement models with their provider networks. Not to mention that almost by definition, these advances will ultimately be cost effective in a value based model that truly focuses on total value. John Poziemski In today’s evolving healthcare environment, providers and payers alike are exploring competitive strategies. What are the key ingredients that health insurance companies need to integrate in order to have a successful payer-provider relationship? Being late to support new approaches can result in serious erosion of market share. Innovative provider-payer partnerships that integrate care delivery and financing are emerging at a rapid pace, ultimately aimed to enhance the essentiality of partnering entities in the communities served. To learn more about how Arlington Healthcare Group can help you define and execute your organization’s strategic plan for transition to Value Based Care & Reimbursement, contact us today. 4 Strategies to Advance Value-Based Care During and After a Crisis. Payers need to support the efforts of providers in their network to minimize inappropriate utilization and maintain quality and service levels. Payers must consider targeted investments and incentives to support provider efforts in the required data measurement, collection, and communication technology. (For more information from the provider perspective, read 8 Provider Strategies for Value Based Care Financial Sustainability.). But without appropriate infrastructure on the provider side to efficiently collect the necessary data and share it with payers, there is no there there. “About four years ago, we had for many years been very good at managing care at the point of service,” Thompson explained. Designing a narrow network and then continuously optimizing its performance is a complex process. The key to cost-effective population healthcare is coordination across the full continuum of services a member might utilize. As an HMO, we had a referral process so we helped members navigate their benefits. Another critical strategy that will keep the payer-provider relationship strong when negotiating value-based care contracts includes keeping the incentives of both parties in order. There will be other opportunities that present themselves. Regardless of the specific role, digital health ecosystems must be a core part of any payer strategy in the future. “When we work with our provider partners and share in the savings that we’re realizing, that continues the cycle of managing the population better in future years,” Thompson concluded. All Rights Reserved. But the positive impact of this can be turbocharged by increasing their patient volume. Top 10 Most Expensive Chronic Diseases for Healthcare Payers, Anthem, Walmart Partner for Over-the-Counter Drug Allowance, Top 10 Highest Performing Medicare, Medicaid Health Plans, How the Affordable Care Act Changed the Face of Health Insurance, The Progress and Challenges of the Affordable Care Act. by Scott Pickens | Jul 11, 2016 | Enterprise Growth, Payers, Value Based Care. Emerging care and payment models, incentive realignment, rapid advances in digital technologies—whatever new challenges may arise, those payers that thrive will transform their business to meet the shifting demands of the healthcare market. Healthcare on the Other Side: Changing Payer-Provider Relationships in a Post COVID-19 Landscape. Many payers have already made some progress in this direction, as their existing portfolios of digital offers and abundant data repositories demonstrate. Healthcare services are simply becoming too expensive for consumers, employers, and taxpayers. Many payers are combining with provider networks to achieve stronger alignment of objectives and coordinated execution of operating strategies. is published by Xtelligent Healthcare Media, LLC. Payers must invest in their internal capabilities to organize and analyze this data. To succeed in an environment of shared risk, payers must extend their data, analytics, and risk management expertise … Research from organizations including the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have identified that healthcare interventions drive only around 20% of population health status. Laura Dyrda - Monday, January 6th, 2020 Print | Email. In fact, GlobalHealth’s strategy to implement data analytics tools and follow quality metrics among their provider network was able to keep this HMO from increasing premium costs among their members in recent years. ", How Payers Should Prepare for Value-Based Reimbursement, Why Payers Should Adhere to Patient Engagement, Consumer Choice, Organization TypeSelect OneAccountable Care OrganizationAncillary Clinical Service ProviderFederal/State/Municipal Health AgencyHospital/Medical Center/Multi-Hospital System/IDNOutpatient CenterPayer/Insurance Company/Managed/Care OrganizationPharmaceutical/Biotechnology/Biomedical CompanyPhysician Practice/Physician GroupSkilled Nursing FacilityVendor, Sign up to receive our newsletter and access our resources. Thanks for subscribing to our newsletter. “We would reach out to members if they had been admitted to the hospital or the ER. “All of those savings that we realize, we pay those forward, keeping premiums low, and improving benefits. Members, providers, and competitors will notice. This is the only way to properly manage the health of its consumer base, as primary care doctors would benefit from having data showing whether their patients were seen at an emergency room or were admitted to a hospital. First, payers operating in new value-based care models will need to ensure greater transparency with their provider network. The power of aligned payer-provider incentives is generally underestimated. The key is to align and tightly coordinate all prevention and clinical healthcare activities across a continuum that includes wellness, primary and acute care, chronic disease management, recovery and long-term care.