July 11 2016 | 0 Comments | 573 reads Average Rating: 4.5

Payers and Providers: 3 reasons to get together

by Rose Higgins in Health Analytics

"Two heads are better than one." It's a common axiom that is widely accepted.

Healthcare payers and providers, however, have traditionally been a bit reluctant to embrace the concept in the past, as they preferred to tread their own paths while working to improve care, enhance patient experiences and reduce costs.

But collaboration is becoming more important as value-based care and reimbursement models are driving closer alignment of clinical and financial outcomes. Here are three reasons why payers and providers need to drop the lone ranger attitude and start to collaborate:

#1: Comingling

Comingling of payer and provider data can provide a 360 degree view of patient behavior allowing for new insights like impactability (a measure that shows which patients/members will benefit most from a particular plan of care or treatment ) and intervenability (a measure that determines patient/ member’s willingness and ability to follow a plan of care). Having access to a complete set of data makes it possible to accurately assess how and where a patients seeks care. For example, if a provider can access additional sources of data that shows a patient with chronic diabetes has also been diagnosed with heart failure, then the provider can better assess intervenability and suggest appropriate integrated care strategies.

#2: Data Transparency

Transparency of data on both sides of the coin will ultimately serve patients better. Rather than viewing each other as opponents in a battle for control over patients/members, payers and providers need to focus on ways to use data to serve patients and the community. With transparency into data, providers and payers can collaborate to work with the high risk populations that benefit all stakeholders. With full transparency of data, opportunities are less likely to slip through the cracks. For example, with alignment around the needs of an impactable high risk population, payers and providers could identify opportunities to work together to deliver care management programs for these populations. A win-win for both sides.

#3: Payer-Provider Collaboration

Working together, payers and providers can better engage patients. After identifying patients who show a high degree of intervenability and impactability, providers and payers can combine efforts to ensure that patients understand and adopt the strategies that will help them optimize their health. Through such collaboration, patients also will see the complete picture of how their active participation in their own care, can realize improvements in their health but that could also benefit them financially under high-deductible health plans.

These are just a few of the reasons why providers and payers should collaborate. Can you think of others?

Rate this Article:

Average: 4.5 (14 votes)

Rose Higgins
SVP & GM, Data and Analytics

With over 25 years in healthcare, Ms. Higgins brings considerable experience and expertise in working with both payers and providers in addressing the challenges of a changing healthcare landscape.

Read full profile and other posts |

Log in to post comments



Arun Rangamani
VP, Payment Services Delivery Leader

Ben Steverman
Chief Technology Officer

David Hom
Chief Evangelist

Jodi Siegel, MSHI, BSN, RN (Guest Author)
Director, wellness and care management

John Pagliuca
Vice President, Life Sciences

Lalithya Yerramilli
VP, Healthcare Solutions

Lesli Adams, MPA (Guest Author)
Director of Population Health Strategy, Oracle Corporation

Linda Pantovic (Guest Author)
Director of Compliance & Risk Adjustment, Scripps Health Plan Services

Mark Feeney
Life Sciences Consultant

Monique Pierce
Vice President, Business Optimization

Nayfe Faillace
Chief Compliance & Privacy Officer

Nicole Stec (Guest Author)
Senior Well-Being Manager, Banner Health

Priyanka Rajkumar
VP - SCIOXpert and Solutions, Analytics

Rena Bielinski
SVP, Strategic Accounts

Rodger Smith
SVP, Payment Integrity

Rose Higgins
SVP & GM, Data and Analytics

Subha Vaidyanathan
VP, Technology and Data Management

Taryn Bevilacqua
Compliance Director


Sign up to receive the latest SCIO news & insights, industry updates, event updates and more, right in your inbox.