The relationship between payers and providers has often been adversarial, but healthcare reform has been changing that – which leaves the former adversaries trying to figure out how to forge new partnerships.
"Traditionally, relationships between payers and health systems have been challenging and even had an adversarial undertone at times," said Kevin Sears, vice president of payer strategy and product development at CHE Trinity Health in Lavonia, Mich. "For some, those challenges remain, but for the most part, we are both working to transform our interactions to be much more collaborative."
There are many components to solid collaboration, but three are key: data collection, transparency and mutual understanding.
Data collection and transparency go hand-in-hand in payer-health system relationships. Data is a powerful tool for both payers and health systems. Payers collect a lot of data, which can provide a broad picture of what is happening in a population and across the entire continuum of care. The health system brings a rich vein of information related to specific components of that continuum.
But all that data has limited resourcefulness without transparency between payers and health systems.
"Transparency of information is one of the key elements of a successful partnership," said Sears.
"Our healthcare economy necessitates better management of healthcare dollars and delivering better value to key stakeholders," he added. "That has caused the hunt for better solutions and led to effectively leveraging the health of defined populations more effectively. As providers and payers come together to manage these populations, sharing information transparently is absolutely critical. We rely on this data to make sure we know what works, and when it doesn't work, we use the information to identify opportunities for improvement."
In order for transparency to work, the collaborators have to understand each other, said John Wray, senior vice president of network contracting and delivery system collaboration at Cigna's New York City office.
In the past, much of the contention between payers and health systems was focused on the hospital wanting to get more money from the payer while the insurers were trying to save money at the request of their customers, employers and individuals. Now, both must work together to reduce waist and improve care.
"There is more competition for total value than in the past," Wray said. "Hospitals and health plans have certain capabilities that can be employed more effectively together."
If providers and payers make an effort to understand each other fully, they are more apt to recognize opportunities that will benefit them both.