During Becker’s Hospital Review’s 2023 Payer Issues Roundtable, in a workshop sponsored by HealthSparq, Paul Merrild, president of Kyruus and HealthSparq, moderated a discussion about the positive impacts of data accuracy and cost transparency on member engagement and how technology can facilitate those goals. Panelists were:
- Reetika Kumar, MD, Market Medical Executive and VP of Strategic Clinical Solutions, Independence Health Group (parent company of Independence Blue Cross)
- Jeff Stewart, director, System Director of Strategic Marketing, CHRISTUS Health
Four key insights were:
- Payer-provider collaboration is a complex relationship that can take different forms. Some health plans in collaborative relationships, such as shared risk arrangements, may choose to provide operational support behind the scenes. “The true relationship lies between a patient and their doctor. Our role is to make sure that we’ve enabled both parties to have a seamless and successful experience and ensure good outcomes,” Dr. Kumar said.
Other payers may focus on uniting the patient/member experience. “For us, payer-provider collaboration means [asking] how do we extend what we’ve always done as a provider into being a payer,” Mr. Stewart noted. (CHRISTUS Health and CHRISTUS Health Plan form part of an integrated health system.)
- Putting out accurate data about which health plans providers work with resonates with a common patient concern. A key factor for patients in deciding where to seek care is whether a physician or a hospital accepts their insurance, yet all too often provider directories on payers’ websites are outdated or inaccurate. This does not help to generate trust with members and health plans are seeking to redress that situation.
- Partnering with technology vendors that bring transparency to provider networks can improve the member experience for health plans. A few years ago, CHRISTUS Health Plan realized its website did not accurately list all the providers who accepted its insurance or listed them differently from how the health system side of the organization did. It partnered with HealthSparq to mine and unify the relevant data, which was scattered across multiple claims systems and therefore prone to mismatches and other errors that undermine trust.
To address a different insurance-related issue, Blue Cross also partnered with HealthSparq to help it surface data on cost sharing, which often differs across providers for patients under the same insurance plan. “None of us would want to show up at a hotel not knowing what am I going to pay at the end of the night — so why do we expect folks to be okay with that in healthcare,” Dr. Kumar said.
- Success in payer-provider collaboration can be tracked using the right metrics. Success metrics include enrollment numbers, online searches that end in booking an appointment and Medicare STAR Ratings. Meanwhile, tracking tools used to capture member sentiment may include heat maps, call recordings and mouse-tracking movements that detect “rage clicks” — an indicator of member frustration that enables payers to understand pain points along the member journey.
