The number of accountable care organizations (ACOs) reached an all-time high in 2018, notes an article in the journal Health Affairs. Today, some 33 million patients in the United States are served by Medicaid, Medicare and commercial ACO contracts.
As value-based care models have become the norm within these groups, which share risks and rewards, the quality of payer-provider relationships has taken on new significance. Today, the ability of payers and providers to collaborate effectively is a prerequisite for any healthcare organization’s success.
Yet while physician practices, hospitals, ancillary services and payers are taking steps to collaborate more effectively, a new survey suggests they could be doing more.
Understanding payer-provider challenges
According to a 2019 survey sponsored by SPH Analytics of more than 80 providers and health plans, 94 percent of respondents say they believe collaboration between payers and providers is now a key determinant of success. Most of the care partners surveyed have specific ideas around what they can do to improve their relationships to achieve value-based goals, which include high-quality care, positive outcomes and measurable cost savings. Additionally, 72 percent of those surveyed say they have already taken important steps to improve their collaboration with other constituents in the care chain.
Much of this hard work is already paying off. Providers and payers have made strides in streamlining data sharing and the adoption of collaborative care models, for example. This is a vast improvement from the recent past, when reports of more adversarial relations between providers and payers were common, including payment delays, micromanagement and rationing care through inconvenience.
But while payers and providers both acknowledge the importance of effective collaboration, the actual execution is still a work in progress. Fittingly, 35 percent of payers and 24 percent of providers highlighted the “willingness to collaborate” as their biggest challenge, according to the survey. One-third of providers and payers also noted that technology is still an obstacle.
There are other challenges, too. Payers cited limited resources (14 percent), while nearly one out of five providers said the value-based contracts themselves were the most challenging aspect of collaborative partnerships.
Given the disconnect between our intentions and what’s really happening, how can payers and providers align their goals? Based on what we’ve seen from the most successful healthcare industry partnerships, here are three key takeaways:
Measure quality consistently.
Payers and providers entering into an ACO or other partnership often struggle to find common ground when it comes to measuring quality. Payers want to set the standard, but providers don’t want to have to measure or treat patients differently based on each payer’s different benchmarks.
Providers and payers need to discuss quality measurements up front and work together to agree on evidence-based quality measures that will address specific population-health goals, based on the provider’s actual patient polulation and its most pressing needs (e.g., management of chronic conditions).