Payers aren't on the 'dark side' of healthcare — the best patient care will come from strong payer-provider relationships

Though healthcare organizations often divide themselves between the "dark" and "bright" sides, with payers and providers swapping sides depending on who's doing the labeling, both groups are actually on the same side.

During a session entitled "Key Issues for Payers in 2019" at the Becker's Hospital Review Health IT + Revenue Cycle conference in Chicago in October, a panel of healthcare leaders discussed the biggest challenges facing payers amid the rapidly changing model of healthcare, and explained why they will need to collaborate closely with providers to navigate those changes.

Panelists included Stephen Johnson, vice president of government and payer relations at Chattanooga, Tenn.-based Erlanger Health System; Angela Breton, vice president of growth and client services at Boncura Health Solutions in Downers Grove, Ill.; and Sheri Johnson, associate vice president of billing and enrollment at Minneapolis-based UCare.

Four major takeaways from their discussion:

  • There's no "dark side" in healthcare — payers and providers must work together to provide the best possible care experience for patients.
  • Ineffective data-sharing between payers and providers leads not only to extra burden on both organizations, but also to patient confusion and extreme administrative expense.
  • Payers and providers can begin to bridge these gaps — and cut costs in the process — by aligning their metrics for success and making a conscious effort to avoid wasting time and energy on initiatives that do not add value nor contribute to a healthier patient population.
  • One of the biggest challenges payers face with regards to regulatory issues is simply anticipating which regulations will actually be enacted. Rather than waiting for regulations to pass (or not), they must rehearse "what-if" scenarios to remain proactive in addressing the difficulties associated with interoperability and behavioral telehealth services, for example.

Don't miss the Becker's 3rd Annual Health IT + Clinical Leadership + Pharmacy event in Chicago, May 19-21, 2020. Click here to learn more and register.

More articles on payers:
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Premiums fell 17% under state reinsurance programs, analysis finds

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