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November 2018, Vol. 6, No. 5

Payer-provider partnerships spurred by data, value-based care

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 ...

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