Connecting Payers and Providers to Enhance the Delivery of Care

Connecting Payers and Providers to Enhance the Delivery of Care

Payers and Provider Care Collaboration Drives Improved Outcomes

Today, payers, including private and public health insurance companies, government-run Medicare and Medicaid, and a variety of managed care plans, are finding ways to expand their role in healthcare. In addition to their traditional functions such as collecting their members’ premium payments, negotiating rates for services, and paying a percentage of provider claims, they are beginning to influence actual care delivery.

When you think about it—even patients who, at times, may have seen payers as barriers to care—it makes some sense. Payers often have the clearest visibility of longitudinal medical records, particularly for individuals who have been members of the same plans for years. This is because, for almost every care event, a claim is filed, and payers accumulate detailed member histories. Oftentimes, payers are more apprised of an individual’s health, lifestyle, and utilization patterns than primary care physicians and other care team members.

Their motivation for this shift is clear. Payers desire better health outcomes, which can lower their costs. When outcomes are improved and costs reduced, their members are healthier, increasingly satisfied, and more likely to be retained. Quite simply, their business depends largely on the administration of care, so why wouldn’t they be more involved, even if their involvement triggers skepticism in some minds?

Healthcare providers have a similar motivation. They also seek better outcomes and related benefits, including the positive impact on their reputation, greater patient satisfaction, the opportunity to execute more effective capitation contracts and valued-based contracts, and even financial incentives. Certain groups, like accountable care organizations participating in the CMS’s Medicare Advantage Plans, can be financially rewarded for their quality of care.

How Is Collaboration Improving Outcomes?

So how exactly are payers and providers coming together to administer care and improve outcomes? And where is this happening?

In a McKinsey & Company article titled “Innovation and value: What payer-led managed-care models may look like,” Emily Clark, Jennifer Rots, and Anna Stolyarova wrote the following:

“Payer-led activity in care delivery has continued over the past five years. M&A [mergers and acquisitions], strategic partnerships, and affiliations between payers, providers, and technology companies have continued as payers seek to expand their role in reimaging care models. As our prior research indicated, these models reorient traditional operations focused on financing healthcare around an integrated model that prioritizes health, efficiency, and customer experience.

In these models, payers take a substantially more active role in the health and healthcare of their members through one of three approaches: provider enablement via a management-services organization (MSO) or other services organization, a platform-based ecosystem convener, or direct ownership of care-delivery assets.”

How Bamboo Health Can Help

There is one key phrase in that explanation that stands out to us here at Bamboo Health: “… payers take a substantially more active role in the health and healthcare of their members…” It stands out because our company aims to improve whole person care for patients across the care continuum. If doing that means better connecting payers and providers—and fostering engagement between them—we’re all in. We’re working to accomplish this via our first-of-its-kind Behavioral Health Care Coordination solution.

Think of our solution as a vast network of payers and providers across the nation, working together in one platform that provides a holistic view of people’s health. Through this platform, they can do the following:

  • Communicate about members/patients.
  • Access near real-time patient data and analytics—including prescription drug monitoring data—directly in clinical workflows.
  • Be notified when patients experience care events.
  • Refer patients to behavioral health facilities.
  • Assess the efficiencies and outcomes of their care plans.

It is an ecosystem that helps both parties redefine how they work in concert to administer value-based care.

“In our eyes, payers have the opportunity to help providers better support their patients. Where this collaboration has occurred, quality of care and patient satisfaction has improved. Our role is to empower collaboration with the alerts, data, and insights providers need to offer their patients the personalized care they deserve,” said Christopher Skowronek, VP, Corporate Strategy and Partnerships at Bamboo Health.

Bamboo Health is committed to remaining at the forefront of payer-provider collaboration. Our Behavioral Health Care Coordination solution changes the dynamic for both parties—and patients. To learn more about it and what it can do for your state or organization, click here.