3 ways to reduce friction in payer-provider relationships

The dynamic between healthcare providers and payers has historically been quite strained. Though both parties are interested in improving the health of their populations, their approaches to accomplishing that goal are often at odds. In this blog post, we discuss how value-based care arrangements are setting the stage for smoother payer-provider relationships—and three ways payers can make the most of this new, collaborative frontier.

1 – Update and expand attribution models

Using a standard patient attribution model across all communities and cases is not sustainable within value-based care arrangements. Instead, work with providers to pinpoint the different populations they are seeing and develop flexible attribution models based on this insight. With this more nuanced approach, you’ll be more likely to get the right roster and payment to providers the first time—which in turn contributes to a more efficient, satisfactory relationship with better quality and outcomes at a lower total cost.

2 – Cultivate a sharper focus on SDOH

One major advantage of technological innovation in healthcare is the ability it has given us to use data to get really precise about outreach efforts and health programming. When payers and providers are willing to lean into interoperability, the insights available can be transformative.

For example, consider two people who present almost identically from clinical risk and basic demographic perspectives, but both are struggling to keep up with their care plans. You could assume that both people are facing the same barrier and deploy an intervention to mitigate the issue. If you didn’t happen to guess the correct problem, you now have wasted resources and solved nothing. On the other hand, you could use advanced analytics from the start to examine social determinants of health (SDOH) data and realize that person A is experiencing literacy challenges while person B does not have access to reliable transportation. Equipped with this information, you can now engage those individuals with interventions and support options that are tailored to address their specific barriers. 

3 – Optimize network management

The value-based care world can be scary at first glance, but one of its major benefits is the way it naturally encourages payers to shift the way they handle provider contracting. Rather than adopting a one-size-fits-all approach, consider engaging providers in the process by showing them the art of what’s possible. This may sound idealistic and fluffy, but we promise it’s not. By taking the extra steps to conduct opportunity analyses with historical claims and encounter information, you can demonstrate what opportunity each individual provider has based on their actual data—and develop a contract that fairly reflects these realities to benefit all parties.

In the not-so-distant past, this type of nuanced data analysis and application would be far too costly and time-consuming to feasibly execute. In the clip below, our resident data science expert Dr. Matthew Hanauer explains how flexible machine learning models are transforming the way payers and providers interact not only with each other, but with data and information that was previously too clunky and confusing to utilize effectively.

To learn more about applying technology to construct stronger care networks and reduced payer-provider friction in a value-based care world, schedule a consultative demo with our team.