Collaborative Relationships Between Payers, Providers Needed to Improve Care

Kimberly White, vice president of Numerof & Associates, Eileen Cardile, MS, the former president and CEO of Inspira Medical Center Woodbury, and Mary Davis, MD, chief medical officer at the Scott & White Health Plan, opened the NAMCP 2016 Fall Managed Care Forum’s business track sessions with a presentation on how physicians and payers can collaborate to improve care and lower costs. 

Their presentation, entitled “Payer/Provider Partnerships: Collaborating on Cost and Care,” aimed to explain what forces are driving the need for payers and providers to collaborate better, what the challenges are to forging a successful collaboration, and the key elements to achieving a successful partnership.

They noted that the current relationship between payers and providers is mostly transaction in nature, meaning that providers offer health care services to patients and payers reimburse providers for those services. Instead, they suggested that payers and providers could be engaging in highly collaborative relationships that could improve quality, improve patient satisfaction, and reduce costs. 

During their presentation, they highlighted many patient and provider collaborations that are already working successfully to improve quality of care. Among these collaborations, were Anthem of Wisconsin’s partnership with Aurora Health Care, Aetna’s partnership with Texas Health Resources, Cigna’s partnership with the JP Network, and WellCare Health Plans’ collaboration with Advicare in South Carolina. 

They stressed that with new demands from the Centers for Medicare & Medicaid Services to switch from fee-for-service payment models, provider/payer relationships are now more important than ever.

Another driving factor highlighted by Ms White, Ms Cardile, and Dr Davis was the pushback from consumers and employers due to rising premiums. They noted that since 2004, average employee contributions to health plans have more than doubled, from $2661 in 2004 to $4823 in 2014. Furthermore, employer contributions have increased from $7289 to $12,011. —David Costill