The Road to Value-Based Care – How Analytics Can Help Payers and Providers Align

Value-based care has been top of mind for health systems across the country, but a recent study shows misalignment between payer and provider groups is impacting the industry’s goal of shifting from volume to value. In fact, 62 percent of health plan executives feel that payers have made progress in aligning with providers, while only 41 percent of physicians agree with this notion.

Contributing to alignment challenges are a lack of tools, data, and technology for value-based adoption. Since both payers and providers offer valuable insight into patient care and outcomes, it’s essential for them to establish a symbiotic relationship to ensure they are on the same page when it comes to care goals, cost-saving strategies and quality management programs. So what steps can payers take to better collaborate with providers and deliver on the promise of value-based care?

Bruce Carver, associate vice president of payer services at MedeAnalytics, believes payers can help by sharing quality data through their analytics investments. These investments enable payers and providers to better collect, integrate, and manage clinical and claims data–providing greater data transparency and payer-provider alignment for value-based success.

Three ways payers and providers can use data insights to march towards value-based care:

  • Measure and record an organization’s performance
    • To improve care, payers and providers need to understand where their organization is succeeding and what areas need work. Analytics can help identify these areas so both groups can align on their goals.
  • Help avoid duplicative care
    • Providers are often left in the dark when it comes to the care their patients receive from different doctors. By implementing a data strategy and analyzing patient claims data, both groups can work together to prevent duplicative efforts and ultimately save time and money.
  • Better identify high-risk and chronic patients
    • By leveraging predictive analytics, population health tools, and patient data, payers and providers can efficiently identify high-risk, high-cost, and chronic patients and develop programs to lower care costs and improve their overall health.

As Bruce outlines in a recent blog post, payers and providers can engage in meaningful dialogue and work more collaboratively to improve care and reduce costs with more holistic views of patients.

If you’re looking to know more about how payers and providers can successfully collaborate on quality care, download our white paper. You can also check out our quality management solution to learn how MedeAnalytics can help in the process.