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Payer-provider relationship key to driving value-based care


Experimentation is the name of the game in a vastly complex healthcare industry. Insurers toy with new, innovative payment methods constantly, and all have a similar goal in mind: improve the quality of care while also lowering costs.

In a recent study conducted by ORC International, sixty-four percent of payers report they are on pace with the transition to value-based reimbursement, FierceHealthPayer previously reported.

So as the healthcare landscape gradually transitions away from fee-for-service payment methods to value-based models, there are an array of strategies both insuers and providers can implement, according to Healthcare Financial Management Association.

Aetna, for example, established a patient-centered medical home with one oncology practice, but the insurer is still not sure about how to fully reimburse for cancer care.

"We think that these new types of contracts are transitions, but each one builds on the other, and the end result will be a win for everyone," Michael Kolodziej, M.D., Aetna's national medical director for oncology strategies, told HFMA.

Like many insurers, Aetna is taking it step by step. The insurer hopes to build its base of oncology practices gradually, while also delivering a high level of care within the value-based model. This way, Aetna can establish a trustworthy network for its members, notes HFMA.

It's important for insurers and providers to team up during this transition period. When Anthem Blue Cross Blue Shield of Wisconsin joined forces with Aurora Health Care and its Aurora Accountable Care Network, the two agreed upon a shared-risk program--Aurora takes on the clinical operating risk and Anthem keeps the insurance risk.

Blue Cross Blue Shield of Massachusetts created a similar shared-risk model. The insurer noted it's important for both payers and providers to share the risks, so not all insurance risk is transferred to providers.

For more:
- here's the HFMA article

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