While they agree that payers and providers must work together to transition to value-based care, executives who spoke at the 2019 World Health Care Congress said various challenges — like breaking down data-sharing barriers and ensuring providers are ready to take on risk — make collaboration easier said than done.
To Jeffrey Conklin, president and CEO of Adventist Health Plan and payer and network strategies executive for Adventist Health, the trap that payers and providers typically fall into is trying to get a better result by doing things “in our same old way.”
“If we’re moving to this new model, then roles are going to have to change, and we’re going to have to be pretty creative together, and trusting about what that’s going to look like,” he said.
Bright Health President Kyle Rolfing suggested that provider readiness is a challenge. Thus, the insurer developed a three-to-five-year road map for moving to full capitation. “The key to that is getting the financial alignment connected to where that capability is, and then how do we help each other get there as quickly as possible over time,” Rolfing said.
At Innovation Health, one way the organization got a variety of stakeholders on the same page was to hold a series of meetings about how they wanted to retool their care management strategy, said Sunil Budhrani, M.D., Innovation Health’s chief medical officer and chief medical informatics officer.
“What we learned out of this exercise was we had higher engagement rates [with patients] if we led with the provider,” he added.
Another way that the organization had to align was around informatics, as “it has been an industry norm in health care that whoever holds the patient’s data is king, and there’s a lot of reluctance to let that information go.”
Conklin suggested that when it comes to data in a payer-provider collaboration, everything should be on the table. For one, there needs to be enough shared information to make decisions from the “same source of truth,” he said. Further, the more data it shared, the more trust is built between the two partners — and vice versa.