Strategies to Improve Payer-Provider Relationship, Data Quality

Improving Payer-Provider Relationship

For value-based care models to succeed, payers and providers need to work collaboratively, identifying gaps in care, promoting high-quality care, and decreasing costs. Many payers emphasized how challenging forming these relationships can be. Providers are busy and often managing several different health plan’s demands. Payers do not want to inundate providers with information they do not need, nor do they want to take time away from the provider's caseload to discuss gaps in care or quality metrics.

The best working relationships between payers and providers at the Summit articulated that the key to success was regular and open communication. In fact, one provider pointed out that the successful relationship he had with one payer allowed him to use these strategies in other payer relationships.

It is in payers’ best interests to work with providers to build the value-based care contract and routinely monitor the contract’s progress. If providers do not understand the quality metrics they are being measured against, they will not be able to succeed. Similarly, providers should feel the quality metrics written into the contract are attainable.

To understand realistic and attainable goals, payers and providers need to collaborate and understand each other’s needs. Promoting a positive partnership will ultimately help improve the success of value-based care models.

Using Data to Provide Actionable Insights

Payers have copious amounts of data at their fingertips. However, many noted that this data is not perfect, so decisions need to be made based on imperfect data.

The importance of data standardization and routine reporting was emphasized, and payers noted how tools like artificial intelligence could help eliminate administrative burdens.

Payers and providers noted the increased importance of using social determinants of health data, whether it is captured through census tract information or social determinants of health screening questionnaires. These factors outside of the traditional care setting must be addressed by payers and providers if they are to improve their patients’ health.

There is a fine line, though, between balancing the data needed to make informed decisions and inundating providers with too much information. Over-reporting information leads to inaction, so payers must ensure the information they give to providers is actionable. If providers do not have the tools they need to address the problems their payers present, the data presented is useless.

Reported data must contain valuable insights that help providers make informed decisions about patient care. Finding the balance between necessary remoting and actionable information can be a challenge that is overcome when payers and providers openly communicate about their needs.

Overcoming Challenges

Conference attendees overwhelmingly articulated that succeeding in value-based care models is challenging. There are many barriers to success that can quickly discourage individuals from entering the field. However, those in attendance provided best practices to overcoming challenges that promoted success in these models.

Ensuring data accuracy was one of the biggest challenges pointed out. If data is not accurate, providers will not use it. Strategies that report real-time data collection and reporting will provide the most actionable insights.

However, too much data can lead to analysis paralysis. Collecting all the information needed to provide actionable insights must be balanced with realistic expectations about an organization's capabilities. Payers should use the most accurate information available to them and be transparent with their providers about its potential shortcomings.