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Make Provider Collaboration Part of Your Cost-Effective Plan Design

By Heather Kerrigan | Nov 9, 2020

Your members depend on their health insurance to stay active and healthy on the job. Advocating for a plan that values payer-provider collaboration can give them a boost toward reaching that goal.

Collaborating to Improve Care

Value-based care rewards providers for the health outcomes they reach rather than the number of services they provide or how many claims they process. A key component of that is payer-provider collaboration — it aims to reduce costs across the board while improving the patient experience through enhanced data sharing.

Under this arrangement, providers send clinical data to insurance companies. These payers then pair this information with existing claims data to form a more complete patient picture. Having that data in hand can help:

  • Track service quality
  • Increase access to the right providers
  • Improve care coordination
  • Encourage evidence-based care
  • Enhance price transparency and lower medical costs
  • Improve overall outcomes

Providing Value for Union and Members Alike

Payer-provider collaboration is a natural extension of integrated benefits, which combine medical, prescription drug, dental, vision and other types of health care coverage. Alone, access to these benefits has the potential to improve health outcomes. When providers and payers team up, data from disparate providers is shared with the payer, who can then expand access to this crucial information for other providers and help members find care that fits their needs. This critical insight can help patients get the right care, diagnoses and medications quickly and efficiently.

Understanding What to Look For

Before you suggest and bargain for health insurance coverage, identify the plans that rely on payer-provider collaboration. Request information about how insurance companies gather patient data, what performance metrics they have in place and how evidence- and value-based care are used to improve outcomes and save money. Specifically, seek out companies that offer:

  • Patient care centers that help members not only confirm benefits but also locate the providers that meet their care needs
  • Competitive costs and transparent pricing
  • Payment to providers based on health outcomes rather than service volume

Communicating Benefits

An insurance plan focused on collaboration may not be typical for your members, and they may have questions or concerns about what these changes would mean for them. It's important to explain:

  • The benefits of this collaboration
  • How to leverage the arrangement to streamline and improve care and save money
  • How their data would be used and their privacy is maintained
  • Any change in cost or covered services

Payer-provider collaboration can produce meaningful results for your members. It's a path to better engaging them in their own health, cutting costs and improving outcomes across the care spectrum.

Heather Kerrigan started her career in journalism at Governing magazine, reporting on state and local politics and policy. Prior to co-founding River Horse Communications, Heather offered freelance editorial services to a variety of outlets, including serving as volume editor and lead author for SAGE Publications' Historic Documents series and editor-in-chief of The Kanter Journal. Heather is the author of the book, Retire Rich With Your 401(k) Plan. She holds a bachelor's degree in journalism from The George Washington University.