Payers and providers: Are you aligned on value-based care?

Value-based care remains top of mind for payers and providers alike. However, continued misalignment between payers and providers can hinder their ability to achieve cost and quality goals. A recent Quest Diagnostics study shows that 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. What’s more, according to an HFMA survey commissioned by MedeAnalytics, an overwhelming 88% of providers say they are not ready for value-based care.

There are many obstacles to achieving payer and provider alignment, including disparate data sources and systems, fragmented stakeholder engagement, and the extraordinary time and resources needed for data orchestration and collection. In fact, a study* by Fierce Healthcare and MedeAnalytics discovered that 68 percent of health plans struggle to integrate various sources when collaborating with providers.

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. By investing in analytics, both payers and providers can better work together in collecting, integrating and managing clinical and claims data. These investments provide greater transparency and alignment for value-based success by increasing the ability to:

  • 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 achieve alignment.
  • 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 at-risk 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, improve their overall health and close gaps throughout the year.

To learn more about how payers and providers can successfully collaborate on quality care, check out our Value-Based Performance Management solutions for payers and for providers.

*Fierce Healthcare and MedeAnalytics, “The State of Payer Analytics,” 2019.