In an interactive session at Becker's Fall Payer Issues Roundtable, Sri Palanisamy, Principal at ZS, led a discussion on unique opportunities and challenges of provider partnerships, particularly for Blue Cross Blue Shield (BCBS) plans. The panel included Jason Hover, vice president of care delivery transformation at BCBS of Michigan; Jennifer Atkins, vice president and chief network officer at BCBS of Kansas City; and Jim Brown, vice president of strategy and operations at Highmark Health.
Panelists explored the critical role of payer-provider partnerships in healthcare delivery, in light of current cost and regulatory pressures and the shift toward value-based care. They noted challenges in aligning incentives, the role of specialty care and the potential for simplifying administrative processes to enhance provider partnerships. Panelists agreed that actionable data is paramount in these collaborative efforts. There was also strong consensus that effective and aligned partnerships can drive better health outcomes and cost management.
Three key takeaways:
1. Local and community ties can bolster value-based care.
Mr. Palanisamy described the range of payer-provider partnerships today, from traditional fee-for-service contracting to pay-for-performance to integrated delivery systems. While an increasing number of healthcare organizations are moving toward value-based arrangements, challenges in economic incentive alignment, building the required infrastructure to execute, and seeing return on investment continue to deter some.
Blue plans, however, are uniquely positioned to drive stronger collaboration and outcomes given their deep relationships with their communities. “They have cost-of-care scale with providers in their backyards and share a socially driven mission to provide for their local communities,” Mr. Palanisamy said. “They've got the local relationships to make these arrangements work.”
Such efforts are longstanding for BCBS of Michigan. Twenty years ago, the health plan started a program called Value Partnerships, which Mr. Hover said helped to build essential foundational capabilities for current value-based arrangements.
“This is unique in Michigan in part because of the scale we have as a Blue plan, the amount of attention and claims that we pay to providers, where we incent them to put in place capabilities that form the foundation of value-based care and paid them for quality outcomes, paid them for some cost outcomes as well,” Mr. Hover said.
Since the program's inception, BCBS of Michigan has saved $6.3 billion. “But more importantly, I think this program set the foundation upon which we can build more capabilities for value-based care,” he said. “People are more prepared to do this work. They've been training.”
2. Actionable data and complexity are key barriers to effective provider partnerships.
Integrating real-time, actionable data into provider workflows is key to value-based care—but achieving this has been easier said than done. “I think we still continue to struggle with data,” Ms. Atkins said. “Being able to get the data in the right place, at the right time, and being able to establish things like Admissions, Discharges and Transfers feeds is just really foundational.”
Mr. Brown from Highmark Health shared a similar sentiment, reflecting on the ‘early days’ of the organization's value-based partnerships.
“When we jumped into the value-based space, we were like, ‘we have to get data to the providers,’” he said. “So every month we'd send a ton of data to providers with no expectation of how the providers were going to actually be able to leverage that information to change care behavior, change patterns or leverage it for insight.”
In the data realm, panelists also raised the issue of transparent cost data for providers. Here, Ms. Atkins said she sees opportunities in the National Physician Performance Dataset that was pushed out to Blue plans.
“We've spent a lot of time thinking about what algorithms we can put in place with that data to help providers redirect or direct patients to the most cost-effective, highest-quality care possible,” she said. “I think that is the next step, making it super easy for a member or the provider at the point of care so you're not creating barriers to receiving that care or an abrasion point with members.”
3. To advance provider partnerships, innovation is on the horizon for Blue plans.
Despite the challenges and complexities discussed, panelists noted their excitement for the road ahead and the many opportunities they see for accelerating provider partnerships.
Mr. Hover, for example, noted possibilities in specialty value-based care. “A lot of our early success has been in the primary care space, but how do you start building that in the specialty side with more models and partnerships?” he said. “You've got to address specialty care because it's a lot more of the spend on the commercial side.”
With Blue plans' unique, longstanding relationships with local providers and employers, Mr. Hover said he also sees an opportunity to facilitate innovative, three-party partnerships that go beyond traditional two-party, payer-provider arrangements.
Shifting arrangements for provider payments is another opportunity area, according to Mr. Brown. “We should change the way we pay, and not necessarily make it pay for a complicated per member per month or a medical loss ratio, but start thinking about what we do really well with our providers and where the provider pain points are,” he said. Possible solutions include simplified administrative processes, gold carding and eliminating or reducing prior authorization burden.
“All those things should lead to better care for the patient and members,” Mr. Brown said.
For BCBS of Kansas City, a continued focus on local collaboration is top of mind.
“Being a pillar of the community or being part of that community, embedded in the community, the things that we're able to do—I think that does drive unique value, and we would like to be there for another 85 years,” she said. “That's our goal.”