Strengthening Payer and Provider Relationships Through Collaboration

By Mark Menton, General Manager, HealthSparq
Twitter: @HealthSparq

The sometimes adversarial relationship between providers and health plans is well documented – and its patients who end up in the crosshairs of the fragmented healthcare system. Amid government mandates, evolving customer demands, and rapid-fire innovation, many providers and plans realize they can’t go it alone anymore. A survey fielded by Wakefield Research in the Summer of 2021 found that 92% of providers want greater collaboration with health plans. And providers have the advantage over health plans when it comes to consumer trust. Collaboration is certainly important on both sides of the equation – there is no doubt that partnerships have the potential to drastically change the patient and member experience for the better.

Below are three key areas of opportunity that provide great starting points for deeper payer-provider relationships as we progress into 2022.

  • Member experience: Health plans, health systems, and the internet at large often have inconsistent and conflicting information about care and provider options. Survey findings show user experience is where providers most want to collaborate with payers. More specifically, providers believe that delivering more consistent user experience and data across payers and providers is the biggest area for patient experience improvement. By exploring ways to make the data people access for decision-making—including pricing and provider profiles—more accurate and consistent between health plan portals and health system websites, there is an opportunity to make healthcare less fragmented and confusing. It’s not an easy ask, but one that payers and providers will need to address as the government and consumers demand more and better information.
  • Value-based care: Everyone wants better healthcare at a reasonable cost. But while value-based care is important to health plans’ ability to manage costs, providers see significant barriers to moving away from fee-for-service models. The Wakefield data shows that more than half of health systems (55%) would like health plans to be more transparent about data shared for value-based care over the next 12 months. To address this, payers and providers need to align on goals for greater cost transparency and data sharing. One way to do this is to bring price transparency data into provider workflows to support cost effective referrals.
  • In-network providers: People don’t make health-related decisions based solely on provider name, specialty, and location—that’s table stakes. Unfortunately, healthcare consumers often have to look for in-network providers at their health plan’s provider directory and then look elsewhere for additional insight into which covered provider is the right fit for their needs and personal preferences. By partnering with providers, health plans can deliver richer data and insights to help people find their provider match while also meeting utilization management goals. Together, health plans can help ensure that people get high-quality care from a provider that meets their unique needs and preferences.

Patients and health plan members will continue to drive advancement and innovation in healthcare and the industry will have to embrace collaboration to succeed. Many innovative health plans are responding to this demand by investing heavily to become the digital health hub for their members. Critical to the success of those initiatives is improving consumer trust and engagement. Collaboration is key to that—along with providing detailed, accurate, accessible information on providers and care options. Yes, collaboration isn’t always the easy road, but it is the necessary one to address the changing healthcare landscape–and it has the potential to greatly benefit patients, health plans, and providers alike.