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Strengthening Payer-Provider Partnership for Value: Why data transparency is key


A transparent, data-driven approach can ease the transition from traditional fee-for-service to value-based contracts.

Value-based care doesn’t have to be a zero-sum game. When physician practices and health plans build collaborative relationships for value, physician practices can achieve healthy margins, while payers can reduce risk—all while strengthening the member experience.

Even still, adoption of value-based payment models remains slow: 64% of physician practices say most of their revenue remains rooted in fee for service, a recent survey found, while just half of practices participate in value-based contracts.

How can physician practices and payers work together to move the needle on value? Establishing data transparency—specifically, access to actionable data—is key. When physician practices understand their historical performance and where opportunities for success exist, their confidence rises, as they no longer fear that their practice does not have the bandwidth to participate in value contracts. From there, physician practices and health plans can use the data to determine action steps for value—such as increasing the percentage of members who receive recommended services—and the types of support that can help practices succeed.

Transitioning from traditional fee-for-service to value-based contracts is challenging, but a transparent, data-driven approach can ease this transition. It can also strengthen payer-provider partnership while improving performance and member outcomes.

Here are three tactics for data-driven collaboration.

Make quality metrics an “open book test”—and communicate regularly around performance.

It’s important that physician practices know not only how their performance will be “graded” under value-based contracts, but also how they are performing throughout the year. Physician practice leaders and health plans should work together to educate physicians on pathways to value, using data to visualize actionable opportunities for improving care, reducing costs and creating a better member experience. These discussions should offer room for physician input into how metrics will be decided upon and why, with an emphasis on the use of data to tell the practice’s value story and potential. A recent Stanford Medicine report shows physicians are ready for these discussions: 47% of physicians and 73% of medical students surveyed say they are currently seeking additional training—including training in advanced statistics and data science—to prepare for new healthcare innovations. When practice leaders and health plans move beyond spreadsheets toward responsive data visualization that illustrates areas where gains can be made, physicians will be more likely to trust that their actions will make an impact. Establishing a regular cadence for data sharing around performance ensures there are no surprises at the end of the performance year and gives the practice time to make adjustments where needed.

Provide data-based tools that prompt value behaviors at the point of care.

For example, at Florida Blue, which operates the largest patient-centered medical home (PCMH) program in the state, the health plan gives physicians the tools to ensure that members with diabetes, chronic obstructive pulmonary disease, coronary artery disease, asthma or congestive heart failure receive recommended services and screenings. The plan also requires physicians in the PCMH to use an e-prescribing tool with decision support. This strengthens medication adherence by helping physicians select cost-effective medications, which is critical given that 50% of patients say they have not filled a prescription due to cost. Florida Blue’s experience shows PCMH providers are more cost efficient than non-PCMH peers, with lower rates of emergency department use. These physicians also score higher on overall quality metrics, according to the health plan. At Christiana Care Health System, which serves patients in Delaware and portions of Pennsylvania, Maryland and New Jersey, a collaboration with Highmark Health equips physicians with actionable dataaround social determinants of health that can help enhance patient outcomes while reducing costs. This payer-provider joint venture is the first to use digital health to enable the move toward value-based care, according to a release.

Give physicians the data to intervene before patient health declines.

During the COVID-19 pandemic, the percentage of people experiencing hardship—from loss of employment to food insufficiency to difficulty paying utilities—has increased, a Kaiser Family Foundation analysis shows. Additionally, 25% of adults reported delayed medical care and 35% reported increased anxiety, according to the analysis.

Further, certain populations have fared worse than others, such as in Oregon, where the state has begun to incentivize providers based on health equity performance. As a result, three-quarters of physicians say social determinants of health will significantly drive demand for healthcare services in the year ahead. In Indiana, the state health information exchange is working with Indiana University to provide social determinants of health data to providers as well as researchers and policymakers to help providers proactively address the factors that negatively affect health. This approach not only has the potential to strengthen value performance, but also limit the long-term health effects of the pandemic on vulnerable communities.

Overcoming Hesitation in the Move to Value

Physicians are hungry for actionable data that pinpoints opportunities for value improvement in as close to real time as possible and compares their performance to that of their peers in similar practices, specialties, and geographies. By ensuring that physicians have the data they need to be successful under value-based contracts—and by telling the story behind the data—physician practice leaders and health plans can jointly establish a foundation for value and trust. The ultimate impacts will be better health, reduced cost, and an elevated patient experience.

About the Author
Emad Rizk, M.D., is President and CEO, Cotiviti.
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