Value-based incentives and other policies of recent years have forced healthcare payers and providers to work together more closely and communicate more often. Such policies include aspects such as risk-sharing financial arrangements and programs aimed at improving the patient experience. Common goals of both parties in collaboration with one another include:

  • Increase patient engagement
  • Improve quality of care
  • Lower healthcare costs

“Collaboration is about how you create the right incentives so everyone is moving in the right direction. It’s easy to agree to in theory—it’s hard to do.”

Healthcare payers

Healthcare payers and providers need to work together more efficiently to meet the goals of value-based care incentives and improve patient outcomes

Barriers are breaking down just recently in light of the value-based care models and other recent changes that have made collaboration between these two entities a must. FierceHealthcare mixed 20 payer and provider executives together at a dinner discussion in Austin, Texas at the annual meeting of America’s Health Insurance Plants. The main purpose of the even was to talk about ways these two entities are partnering together to create better outcomes for patients and members.

The engagement also provided an opportunity for them to share advice and discuss frustrations, challenges, and successes with each other. Participants of the discussion included CEOs, chief operation officers, directors of business development, chief information officers, and directors of strategy and payer relations. The organizations that sent representatives ranged from small practices and regional health plans to national insurance companies and large healthcare systems.

A payer executive that attended the meeting had the following to say:

“We want to improve their (the patients’) experience by getting that information from the physician’s office, so we can get them set up on the pharmacy side. Those are the gaps that we’re trying to bridge through provider integration.”

Another meeting attendee commented on how to make the integration happen, saying, “Collaboration is about how you create the right incentives so everyone is moving in the right direction. It’s easy to agree to in theory—it’s hard to do.”

 Tom Turi, SSI’s Chief Payer Solutions Officer, leads SSI’s Payer interactions. He maintains existing Payer relations and accelerates growth with new Payer clients and additional value-add solutions. 

Technology to Promote Collaboration Among Healthcare Payers and Providers

Multi-payer and online portals are underutilized tools that can be used to help payers and providers communicate in order to help mitigate costs and improve patient outcomes. Both these entities share common goals, including successfully completing value-based initiatives. Yet barriers such as administrative burdens, poor data transparency, and competing business goals leave these partnerships weak in many aspects.

A recent study conducted by Availity, a healthcare IT company, revealed the following about the use of such technology among healthcare professionals:

  • 60 percent of healthcare payers prefer to communicate with providers via online portals as primary source for collaboration
  • 39 percent of providers in the practice setting and 40 percent of providers in the facility setting strong support online portals as the primary communication source
  • The majority of both groups believe that greater profitability can be reached through improved collaboration.
  • “All respondents agree that any proposed solution must be easy to use, a good value, and reduce staff time.”
  • An average of 76 percent across all groups viewed “administrative waste as a significant contributor to ongoing communication problems.”

Brian Kagel, Availity’s director of market research, said in a statement.

“Providers communicate, on average, with 17 to 20 payers a week, so the problems associated with administrative waste can have an amplifying effect. Often, representatives from multiple payer units will unknowingly contact a provider seeking the same information, leading to provider abrasion. Until providers and payers can address this challenge, it may be difficult to accurately measure value-based outcomes.”

Real-time Transaction Processing Services for Payers

SSI Claimsnet provides a secure connection that works online to minimize expenses associated with claims submission and payment and speeds deployment. This solution serves as an extension of a payer’s EDI or IT department to complete the work that teams would otherwise be required to complete. With Claimsnet, healthcare payers gain the ability to accept claims not only directly from providers, but from all clearinghouses, thereby reducing the need to maintain those connections independently.

With SSI Claimsnet, your organization can…

  • Eliminate the lag time between claims submission and payer acceptance
  • Minimize the expenses normally associated with claim submission and payment
  • Simplify the claim standardization process
  • Streamline your administrative process and reduce administrative costs

Visit our Claimsnet page to learn more about this solution, or request a live demo today.