PwC Report: With Population Health, Payers and Providers Have to Play Nice

The initiative uses Watson, which became famous for winning on the game show Jeopardy!, and its ability to process an abundance of clinical information to help better guide the clinician when they are treating the patient. “The level of investment [for this initiative] is not something all payers and providers can make, that really is leading edge. But it’s a great example of where the future practices of medicine can go through aligned partnerships.”

Evolution of Incentives

Edwards is confident about the future potential of the payer-provider collaboration and how this can expand beyond those who are leading edge. Thanks to incentives from the Centers for Medicare and Medicaid Services (CMS), Edwards says, there are now more reasons than ever for payers and providers to collaborate. He cites the measures for the CMS star ratings for Medicare Advantage plans, and how medication adherence is highly weighted. When this went down, Edwards says, it made the payers realize they had to partner with health systems to hit those measures.

“It caused new conversations to occur by taking the traditional incentives of the right drugs are being prescribed to the [new incentives] the right drugs are being taken. As that continues to evolve, it could be the right diseases under control because we’re seeing right value,” says Edwards, who doesn’t see the train stopping any time soon. “This evolution is occurring rapidly and it’s taking us beyond more traditional incentive programs into more shared risk around the reward programs and towards more value-based measures.”