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.

On the financial side, providers are looking for ways to make their fee-for-service business more efficient, increasing revenue. Meanwhile, insurers can use the data to spot highest utilizers of care to measure that against their premiums and negotiated payment rates with healthcare providers.

But what's really interesting is that it's the providers who are starting to think like payers as the industry move towards value-based care and population health.”

Within our client base we are seeing them target specific data points to mitigate cost and risks, specifically: 

“Many payer clients want to track pediatric prescriptions of asthma medicine albuterol in a certain state, looking to find out which children hadn't filled their prescriptions in the past three months.

The way the payer thinks about it is: If those children don't fulfill that $20 script then we'll apply predictive analytics to determine how many of those kids are going to end up in the emergency room. Then there can be intervention and the payer saves on a $1,500 ED visit.

That's the kind of thinking payers have long held, since unnecessary hospitalizations meant they had to shell out cash for medical care that could have been avoided. But that's not how providers traditionally thought under fee-for-service.

Not to sound harsh, but in the past it wasn't part of the business model for the provider to care about whether that kid fulfilled that script because when they showed up in the ER the provider was going to get paid for it. But today in value-based reimbursement, they're going to get paid a single amount of money to manage that child's asthma care. It's now in the provider's best interest to understand who filled that script.”

To learn more about my insights on population health and payer/provider collaboration, read the full Healthcare Finance News article, “Insurers, healthcare providers find common ground in population health data, MedeAnalytics CEO says.”