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At Long Last: The Glass Is At Least Half-Full on Payer-Provider Collaboration in the New Healthcare

June 17, 2014
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Payer-provider collaboration is real—and it’s reaching a new inflection point, around the opportunity for payers and providers to work together with data, for real results

In every industry, there are inflection points worth noting, moments when it feels as though molecular structures suddenly realign in novel ways, and old certainties suddenly become uncertain. That’s how it felt listening to the discussion on June 10 in Chicago, as I covered a session at the Health IT Summit in Chicago, sponsored by our sister organization, the Institute for Health Technology Transformation (iHT2). The session, entitled “Transforming the Payer-Provider Relationship: Aligning Business Models for Improved Outcomes,” involved a moderator who is a consultant and analyst, the chief medical officer of a physician-hospital organization, the COO of a provider-sponsored health plan, and the CMO of a multi-state health plan umbrella corporation.

What was clear from the start was the fact that none of the panelists had come to posture or make rhetorical statements, none had any particular axes to grind, and none were there to batten their proverbial hatches against the future. On the contrary: every one of the panelists in that discussion was helping to lead an organization that is involved in true payer-provider collaboration. What’s more, all were focused on data-centered collaboration, in the emerging era of accountable care, bundled-payment contracting, patient-centered medical homes, outcomes measurement and value-based purchasing, and population health management and readmissions work.

The discussion last Tuesday really brought me back to my earliest days in healthcare publishing, 25 years ago. I came into the industry as the managing editor of a publication for physicians published by a state medical society. That medical association was one of the most reactionary of any I’ve been aware of in the years I’ve been in healthcare as a journalist and editor. The senior executives of that association saw the world in very stark terms, with independent, non-salaried, private-practice physicians as the core figures in an us-against-them, no-compromise, maximized-revenue fee-for-service practice and policy environment, and they were determined to crush managed care, outcomes measurement, and policy oversight and regulation of physicians as anathema to everything they held sacred.

Granted, the managed care of 1989 was primitive, punitive, and reductive in many ways. It was what was rather accurately disparaged as “mother-may-I” managed care, and seemed, to the physicians, to be all about maximizing health insurer profit while pushing down crudely on utilization. What’s more, health insurers in that era had no really worthwhile tools in their arsenal, and neither did physicians (or hospitals, for that matter). And, on top of everything else, within a few years after that, meaning the mid-1990s, a wave of speculation-driven physician practice management companies (PPMs or PPMCs, as they were known) rushed in to try to profit off aggregating physicians, while adding virtually no real value. (Not surprisingly, the three largest PPMCs ran up market share as public companies and then all promptly collapsed in a conceptual heap soon after that, as they failed to demonstrate value for business activity).

Fast-forward to 2014, though, and we’ve got rapidly universalizing electronic health records and clinical decision support tools; population health management, health risk assessment, and data analytics tools; clinical informaticists and other healthcare IT leaders able to bring key tools to the point of care, point of service, and point of analysis; technologies to support mobility, health information exchange, and performance dashboards for clinicians; and, most importantly, broad policy mandates like the Affordable Care Act, the HITECH Act, and others, that are pushing healthcare very rapidly into mandated value-based purchasing, readmissions reduction, and other initiatives in healthcare. And we’ve now got a sizable group of leaders—physicians, nurses, clinical and non-clinical informaticists, c-suite executives, boards of directors, and others—who can see the new healthcare—a U.S. healthcare system driven by value, not just by volume—and who are rapidly moving towards that new healthcare, and providing great templates for everyone else to follow.

So listening to Cathy Dimou, M.D., Scott Sarran, M.D., Dan Hounchell, and Cynthia Burghard talk about data-driven collaboration was exceptionally heartening, not only because I firmly believe that collaborating on data in order to manage the health of populations is a natural, logical place for providers and health plans to start, going forward; but also because the tone of the discussion at least week’s iHT2 health IT summit exemplified the kinds of conversations that will need to take place in thousands of conference rooms all across the country, as we move, sometimes stumbling, towards the new healthcare.

For the first time, really, on a broad scale, this much is clear: providers and payers have a lot in common, as everyone tries to unlock the Gordian knot of challenges around making the U.S. healthcare system higher-quality, lower-cost, and of greater value for everyone. And the desire on the part of both providers and payers to roll up our collective sleeves and dive into the data together—no longer separately—on behalf of patients, plan members, and whole communities—has never been stronger or clearer. So the glass is definitely half-full when it comes to this kind of collaboration these days—and it’s about time, don’t you think?