The U.S. healthcare system has many challenges. At the top of that list of challenges is a siloed system where everyone operates in their own sphere, never collaborating and sharing information that could actually lower costs and improve care. As the entire healthcare system shifts toward risk-based models, that collaboration is essential to success.
Payers alone cannot address the rising costs and mediocre patient outcomes (compared to peer nations) that are prevalent in our healthcare system. They need provider partners interacting with patients to close gaps in care and help mitigate high-cost interactions, such as avoidable ER visits and hospital readmissions.
Fostering trust through transparency, and empowering providers by translating valuable analytics insights into actionable steps that improve care, ensures everyone can achieve the clinical and financial goals while maintaining the highest quality patient care.
When payers push for providers to take on more risk in value-based care arrangements, they must clearly delineate the metrics, incentives, and actions that will make a difference for a given member or population. Without that data, providers are like pilots trying to fly an airplane blindfolded. Some may get lucky and land the plane, but most will fail. The results of the information gap will likely prove detrimental to the health and well-being of your members.
The shift to value-based care is a big one, particularly for providers who have worked in a broken fee-for-service system for years or decades. Focusing on outcomes over volume is a new concept for many. Provider partners should be empowered with data on:
In addition to providing the reports, providers deserve the ability to drill down into various metrics and measurements to see the underlying data. They can independently verify the validity of that data, which builds trust and empowers them to meet their goals. This level of data sharing and collaboration is often a big shift from the siloed approach of the past. Payers may be concerned with sharing too much data or revealing proprietary information that gives them a competitive advantage. To prevent that, a software platform that makes it easy to control access to information based on user roles is also important.
Healthcare information comes from a wide variety of sources, including claims, clinical and EHR, and health equity data. Deriving actionable insights from these various sources requires advanced data management capabilities to ingest, cleanse, and standardize the information, then stitch it to individual members so everyone is working from the same dataset.
Once payers have these 360-degree insights, the next step is to share them with provider partners and empower care teams to create workflows that address critical and timely member needs. Clinical decision support tools that deliver these insights and actionable steps directly to a clinician at the point of care lead to more cohesive and streamlined care – and better outcomes.
Navigating a future where risk-based payments models replace our current fee-for-service system won’t be easy. When payers and providers partner together, it’s easier to work toward our ultimate shared goals of better care at a lower cost, and better outcomes for everyone. We can only achieve that when the foundation of that partnership is built on trust and transparency.
