Top Priorities for Payer Executives Today

At the first Becker’s Payer Issues Roundtable event on November 7-8, a leadership panel discussed payers’ top priorities.

  1. Payer executives are concerned about how to manage the cultural shift to move to value-based care. “The reality is we live in a fee-for-service world, and in the short term, it does mean that somebody is going to get a smaller piece of the pie,” said Ceci Connolly, President and Chief Executive Officer, Alliance of Community Health Plans. “But true value-based care has to include downside risk for both players in the arrangement.”

  1. Managing price transparency has caused confusion for members, and health plans must educate about the value that integrated models can provide. “Everybody's got their prices out there, and it might be a little bit more expensive for you to get your colonoscopy with us than it is with one of our competitors,” said Gracelyn McDermott, Vice President, Marketing, Sales and Business Development, Kaiser Permanente. “But what happens if they find something? That’s really where the member starts to lose the value (if they are not covered by an integrated model).”

  1. Consolidations haven’t resulted in savings but have rather brought more bargaining power to a few, large entities. This is an important regulatory topic, according to Connolly: “What are policymakers going to do to attempt to level the playing field to have true competition?”

    For smaller players however, the panelists have already observed more creative partnerships between payers and providers which will be critical for them to remain competitive. “We've reached the tipping point where the healthy friction and tension got to an unhealthy point, and people are more willing to lay down arms and work together,” said Michael Drescher, Vice President of Payer Strategy, XSOLIS. “Increased sharing of real-time data needs to become the norm, not the anomaly, to accelerate the collaboration the industry requires.” 

  1. Concerns about cost-shifting and staffing shortages loom large. Economic trends will make the need for efficiency across health plans even more pressing. Health plans with balanced portfolios should be better positioned to manage the money and the patient population.

    With the industry suffering provider shortages earlier than expected, health plans must continue to balance telemedicine and other care delivery options to ensure members are receiving the right care at the right time and place for the right price. Drescher adds, “Whether it’s a good time or bad time with Medicaid reimbursement or commercial lines, there is still an enormous amount of administrative waste in the system, and we’re not talking enough about getting rid of that with innovation.” 

As detailed in a recent Chilmark Research report, Humana is one such example of how health plans are partnering with XSOLIS to reduce administrative waste and foster more payer-provider collaboration.

To learn more about XSOLIS, click here. For information on the upcoming Becker's Payer Issues Roundtable April 3-4, 2023, click here.
 

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