Payers positioned to lead alternative payment model transformation
Current battle: Get providers on board
For many payers, alternative payment models are nothing new. Take Capital BlueCross. Since 2010, the insurer has had initiatives under its belt such as its accountable care arrangements, Jay Simmons, vice president of provider network engagement (pictured right), told FierceHealthPayer.
The shared-savings model, which stems from the primary-care medical home concept, may look like an accountable care organization but focuses more on primary care. Because the program is more PPO-heavy, without many HMOs involved, Simmons mentioned the challenge of establishing relationships with providers.
"Most providers aren't ready for this transfer of full risk," noted Simmons. "There's a lot of hesitancy from the provider community."
Amy Fahrenkopf, medical director and vice president of transformation at Highmark (pictured left), brought up a similar point: Providers need to gain more experience before they go full-risk. But, as Fahrenkopf told FierceHealthPayer, it's no easy task to change an operating model.
Use technology to engage providers
For Highmark, technology plays a key role in forming alliances with providers. The insurer uses IT to turn a combination of clinical data and claims data into actionable insights for providers. Providers, in turn, can incorporate this information into their workflow. The end result, as Fahrenkopf put it, is real-time data.
Of course, the right IT solution may not carry out across the board. Insurers realize that each market in every state is different; there's not one-size-fits-all model.