All together now: 3 healthcare executives on the new normal for payer-provider relationships

Payers and healthcare providers were traditionally seen as having conflicting goals — payers wanted to cut expenses, while providers wanted to provide quality care regardless of cost. However, as the healthcare industry evolves and implements outcomes-based payment models, health insurers and providers are collaborating more than ever before.

At the Becker's Hospital Review 4th Annual CEO Roundtable + CFO/CIO Roundtable in Chicago, three healthcare industry executives from the payer and provider sides discussed the most interesting and innovative partnerships with which they are involved.

Sinai Health System Executive Vice President and CFO Chuck Weiss said exploring ways to bring value is important when developing partnerships with payers. The Chicago-based safety-net system created a partnership with IlliniCare Health, a local Medicaid provider known as Centene nationally. IlliniCare wanted to get in the public exchange market with plans for individuals at 250 percent the federal poverty level or less, which is a "Mount Sinai sweet spot," according to Mr. Weiss. The two joined forces, and IlliniCare debuted a product co-branded with Sinai on Nov. 1, which quickly became the No. 1 product on the Illinois insurance exchange.  

Regarding the success of the partnership, Mr. Weiss said, "Clearly…this is where the payer and partner hospital system came together and created something that we know is specifically going to deal with populations in our communities and cut their costs. It's really all about bringing care back to the patient."

Mr. Weiss said Blue Cross Blue Shield, the largest insurer in Illinois, is another payer that understands the value of safety-net providers. BCBS was previously strictly commercial but is now one of the biggest Medicaid providers in Illinois.

Richard Migliori, MD, executive vice president of medical affairs and CMO of UnitedHealth Group, echoed many of Mr. Weiss' thoughts on payer-provider partnerships. He said collaborating with healthcare organizations is simply part of doing business today. "We're finding ourselves on the same side of the table trying to solve problems," he said.

Along with payers and providers, Dr. Migliori noted another important piece to succeeding in the current healthcare environment — consumers. "The real value in healthcare can be driven when payers, providers and even consumers are working toward the same goal of identifying waste and eliminating it," he said.

Although there are numerous benefits of increased collaboration between providers and payers, Valinda Rutledge, vice president of public payer strategy at the Care Coordination Institute in Greenville, S.C., warned providers to "proceed cautiously" and take it slow when entering into risk arrangements involving a commercial population.

"The one thing that surprises me is the number of systems that want to rush into making a deal with a payer at an [accountable care organization] level," she said. A better approach for many systems is to start with some sort of shared savings arrangement that has no downside risk for the first few years, according to Ms. Rutledge.

More articles on payer issues:

UnitedHealth CEO: Participating in ACA exchanges was a 'bad idea'
Fitch: Health insurer margins feeling pressure from ACA exchange enrollees
UnitedHealth may exit ACA exchanges due to losses: 7 things to know

 

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