Why a Collaborative Payer is Needed for Value-Based Care Success

Authors:
Matt Farnum, Vice President, Health Plan Accounts
David Corrigan, Vice President, Expansion and Operations

As value-based care gains traction, provider groups and health systems are finding that managing populations effectively requires tightly aligned business and care delivery models. To be successful, providers require a collaborative payer to support the operational capabilities required to manage risk. But what is a collaborative payer? Most payers lack the traits of being a collaborative partner, and providers have seen limited success in achieving substantial value-based objectives.

Whether your organization is looking to partner with a collaborative payer in your market or become a payer, it is essential to understand what is required for success.

What is a Collaborative Payer?

A collaborative payer is a true partner, aligning incentives, coordinating operations and engaging providers to deliver higher quality, cost-effective care.

Aligned incentives: Contrary to the traditional win-lose approach to contracting, a shared focus on both financial and clinical outcomes is necessary for sharing risk with providers. Successful collaboration starts with aligned incentives—among the payer, provider, and consumer. Collaborative payers work with providers by offering:

• Win-win contracting
• Balanced provider incentives across quality, cost and access
• Measurable and achievable metrics
• Consumer benefits aligned with population health goals

Coordinated operations: Health plan operations must facilitate effective payer-provider collaboration, minimize physician abrasion, emphasize consumer satisfaction and promote cost effective, high quality care. A collaborative payer will focus operations on:

• Timely and actionable clinical and financial data
• Coordinated programs avoid duplication and minimize friction
• Data-driven continuous improvement

Engaged providers: A payer’s success is dependent on the provider groups’ success. Collaborative payers will partner with providers on:

• Education and training in value-based care
• Practice transformation support and resources
• Best practice sharing

What can Providers do Next?

Collaborative payers are still rare in the market, but providers need them to succeed in value-based care. Finding a partner with the proven experience and outcomes to operationalize a collaborative payer model will enable your organization to achieve improved financial and clinical results.