Payer and Provider Collaboration Ensures the Industry is Tracking Towards Value
Collaboration between payers and providers is an important asset to improving quality of care across the healthcare ecosystem, while simultaneously keeping costs down. For example, payers have access to a significant number of claims data that creates a holistic view of patients’ information, while providers typically have discrete clinical data information. By working together to exchange this information, payers and providers can stay on top of patients and ensure they are getting quality care and avoiding high-cost events, such as visits to the emergency room. Also, with value-based care top of mind, payers and providers need to work together to leverage data and analytics to reach that end goal. We talked to Bruce Carver, Associate Vice President of payer services at MedeAnalytics, for his insight on the current challenges that prevent payer-provider collaboration, best practices to achieve it and why it’s useful.
Challenges that can arise within collaboration
When it comes to payers exchanging information with providers, storing clinical data received from an electronic medical record (EMR) is very expensive. There is no standard format across the U.S. for providers to implement that information simultaneously. Oftentimes, payers don’t want to add another system to store that information, instead integrating it through an EMR that can be sent out from a provider’s system and to a payer. In addition, providers have access to more timely data as well, enabling immediate outreach to patients. Ultimately, collaboration is needed so both the payer and provider are on the same page when it comes to treating patients. If either doesn’t have the complete information, it can result in gaps in care and ineffective treatment.
How analytics can help
Analytics can provide additional ways that a provider and payer can exchange that clinical information. In an EMR, there are hundreds of different measures and metrics that are collected within that provider’s system but oftentimes only a small portion of that is necessary to be able to collaborate effectively for the value-based programs that are in place. MedeAnalytics has enabled external use of its platform by a provider to be able to attach and upload that information straight into an analytic tool that is used to measure results of the program, which makes for a more cost-effective solution.
CHIME Series: Are you making the most out of payer data?
This week, we continue to explore the results of our College of Healthcare Information Management Executives (CHIME) survey and the need for various data sources. Our survey asked the question: Do you have a strong grasp on how to deal with payer data today? The results show that the majority (57 percent) of provider organizations do not.
As healthcare costs continue to rise and the industry focuses on value-based care, payers and providers need to look for ways to collaborate. This relationship is critical to payers as they leverage EHR data to better understand the cost of services rendered by the providers, measured against the outcome of care. For providers, combining both claims and clinical data can reveal some extremely valuable insights that can positively influence clinical decisions and drive down costs. However, many organizations still face challenges, including a lack of appropriate tools and an influx of data that is difficult to manage. This then creates a lag in insights being delivered to the right people at the right time. Bruce Carver, associate vice president of payer services, believes optimized organizational coordination can help address some of these issues.
Here are two of his best practices for making the most out of payer-provider collaboration:
- Trust Each Other– The first step in any relationship is trust. Are your goals aligned? Do you have redundant reporting or processes to get to these shared goals? Where can things be streamlined? This relationship will take time as both parties must work together to improve collaboration and ultimately gain more insights.
- Establish Communication Processes – Communication is also key and establishing efficient processes can help ensure that organizations are on the same page when issues arise. Some of these issues include, gaps in payer data or instances when payer data is not directly aligned with provider data.
Once organizations are aligned, payer data can be leveraged to better meet industry-wide demands of becoming more patient-centric and value-driven. This collaboration can also help providers manage medication adherence and establish cohesive strategies that address this issue.
As providers continue to struggle with a lack of organizational resources and payers begin to shrink in numbers, payer and provider collaboration will be more important than ever. Additionally, creating this collaboration can help both parties ensure that they are on the right track towards value. To see more results from our CHIME survey, access recent blogs here and here. If we can help get your organization on the right track, make sure to contact us.
With or Without ACA, Payers Should Continue to Invest in Analytics Capabilities
With the turn of the new year and the new presidential administration, the potential repeal and replace of the Affordable Care Act (ACA) has dominated headlines and payers have been left in a state of uncertainty on several major issues. From the 20 million people that could become uninsured, to the removal of the individual mandate and corresponding spike in premiums, health plans are bracing themselves for unknown market instabilities.
However, payers should not lose sight of what they can control today: how to leverage data in a healthcare economy that is defined by value over volume. We connected with Bruce Carver, associate vice president of payer services, to shed light on how critical it is for payers to have a strong data-driven strategy in 2017 to prepare them for forthcoming regulatory changes.
Payers play a unique role in healthcare as they can offer providers access to robust data on their member population. That data, however, is not actionable without proper analytics that can identify potential cost savings via patient care gaps and high cost populations. In 2017, here are three evergreen cost saving areas to focus on:
- The individual market – trend where risk existed over the last three years to understand what you can take on from a cost perspective in the future. This retrospective analysis will allow payers to make strategic decisions on how to approach and cater to specific member populations, like those suffering from chronic diseases.
- Gaps in care – identify gaps in care that are driving down value, work more closely with providers and outline strategies that can start to drive down the bad debt caused by these gaps. Collaboration with providers is the only road to quality to create a holistic patient record. Start collecting information on everything from claims and demographics to clinical data generated by the electronic health records of multiple providers.
- High costs –establish a trajectory of where you are spending the most and use your data to analyze where that spend may be in the future and to course-correct throughout the year. No regulatory mandate will ever change the fact that payer organizations need to have a strong understanding of their profits and losses. Is there an at-risk patient population that needs more interventional resources now before they progress to a chronic condition? Are some of your high cost groups associated with medication adherence issues? These are just some questions to ask and address when examining spend vs. value.
Insurers and Healthcare Providers Find Common Ground in Population Health Data
Earlier this month, I spoke with Henry Powderly, Editor-in-Chief of Healthcare Finance News to discuss the major shift in the healthcare industry with population health management. Henry and I focused on the growing payer and provider collaboration and how MedeAnalytics is adapting to meet the needs of our customers. Here are a few key takeaways from our conversation:
“While payer-provider collaboration has long been important, new trends in managing population health data is strengthening that relationship as never before, and in many ways it's changing how providers think.
A growing number of payer clients are leveraging the exact same data, but they're asking questions in a different way, adding that the company has seen more insurers sign on as clients recently.
Data Analytics to Improve Medicaid Care and Costs
As the healthcare industry shifts to value-based care and fine-tunes their efforts to lower unnecessary costs, Medicaid state agencies have looked to major players in the healthcare data analytics space. This leap is of course not easy for many of these state entities but the Mississippi Division of Medicaid (Mississippi DOM) offers a shining example of how to successfully leverage data analytics to improve care while reducing costs. Several other state Medicaid agencies have already tapped on Mississippi DOM for insights and best practices for adopting a similar initiative. I predict that we’ll see many other states making the leap into big data in 2015 to align their payments with quality and value.