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Payer-provider partnerships spurred by data, value-based care
This article is part of the Pulse issue of November 2018, Vol. 6, No. 5
Payer-provider convergence combines two traditionally disparate interests -- the healthcare systems that deliver care and the insurance carriers that assume the financial risks for patient populations. It encompasses the technologies and strategies that promote a more efficient and transparent exchange of information between healthcare payers and providers to improve care and lower costs. In response to providers and insurance carriers assuming more risk, growing concerns with negotiating fair reimbursements and a shift from volume- to value-based payment models, payer-provider partnerships are emerging as a trend that may someday sweep the healthcare industry. Value-based care a catalyst for convergence "The main reason payer-provider convergence has become more predominant in recent years is the migration to value-based care and that modality of reimbursements whereby there is some matter of risk involved in managing the population," said John Moore, CEO and founder of Chilmark Research. "This was started primarily by … the ...
Features in this issue
Once they were two groups with conflicting interests, but now the convergence of healthcare payers and providers is more common as the industry struggles to control costs.
Taking an untraditional route to value-based care, payer-and-provider partnerships highlight the collaborations between benefit planners and healthcare systems.
See how IT executives at two healthcare organizations weed out patient identification errors related to duplicate medical records -- a significant problem, according to research.
News in this issue
Clinicians, health IT professionals, insurance carriers and others have started a slow roll toward improved patient outcomes using methods based on healthcare reform.
Columns in this issue
Our columnist's research indicates that value-based care is prompting the creation of 'payviders,' but the pace is slow. Technological considerations also come into play.
The healthcare industry is beginning to warm up to AI, as the technology helps providers make clinical decisions and assists with certain types of surgery.