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Payer-provider collaboration essential for improving population health

Payers and providers must be ready to emphasize prevention, disease management

To start playing a more central role in population health management, payers must consider the provider contracting process as a partnership, Healthcare Payer News reported.

Though hospital systems define population health differently, and collaboration opportunities therefore vary, payers must understand that providers increasingly aim to shift from the traditional fee-for-service model to one that rewards health systems for keeping patients healthy.

Forward-thinking payers--especially those who see the accountable care organization (ACO) model as a way to achieve the triple aim (better care, improved health and reduced costs)--understand that embracing population health means emphasizing prevention and disease management, as well as a return to primary care. That's a notion on which both payers and providers can agree, Healthcare Payer News said, citing the efforts of Aetna, Humana and various Blue Cross Blue Shield organizations to better focus on primary care services.

There are barriers to overcome, however. Doctors have been leery of sharing risk with payers in value-based reimbursement, FierceHealthPayer previously reported, in large part because they distrust payers. To improve payer-provider collaboration, insurers must be ready to share as much data as possible and to collaborate at the organization level, not just at the practice level.

Seth Frazier, chief transformation officer at Evolent Health, a joint venture of The Advisory Board Company and the University of Pittsburgh Medical Center Health Plan, told Healthcare Payer News that improved collaboration will help payers and providers scale population health management across commercial, Medicare and Medicaid patients. A larger population means a broader base for driving innovation, he said.

For more:
- here's the Healthcare Payer News article

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