How To Collaborate In The Current Uncertain Year

More Transparency – And Data Sharing – Would Be Appropriate
By Rose Higgins

                If there is one word that accurately encapsulates the overall healthcare outlook for 2017 it’s uncertainty. 

Will the campaign pledge to “repeal and replace” the Affordable Care Act (ACA) be strictly adhered-to, or will the more recent indications of a desire to keep some portions and amend others be followed? Will Medicare remain as it is, be privatized, or go some other route? What changes will the new Secretary of Health and Human Services bring in the way healthcare is administered and reimbursed in the U.S.?

At this point, much is up in the air. And it’s making many people nervous. While there are no guarantees, especially in such turbulent times, it’s highly likely that one initiative that came out of the ACA – the journey toward accountability and value-based care – will continue no matter what other changes occur. Mostly because it makes so much sense no matter which side of the aisle you’re on.

                Since this type of shared risk brings clinical and financial success into such close alignment, it is in the best interest of everyone for payers and providers to break down the walls and collaborate more effectively and completely. Following are three keys to getting there in 2017.


Data Sharing

                Payers and providers each have powerful datasets that can tell a lot about a patient/member. Put them together, however, and you gain a 360-degree view of patient behavior that enables superior insights – especially around impactability (a measure that shows which patients/members will benefit most from a particular plan of care or treatment) and intervenability (a measure that determines the willingness and ability of patients/members to follow a plan of care).

                Having access to all the data provides a more complete picture of how and where patients seek care across the continuum of care. For example, if a provider can access payer data that show a patient with chronic diabetes has also been diagnosed with heart failure, the provider can make better decisions regarding intervenability and suggest appropriate care strategies.


Improved Transparency

                Payers and providers have always tended to shield their data from the other’s view, keeping it close to the vest for a variety of reasons. That needs to stop now. Instead, they should focus on ways to make it easier to share data to serve patients/members and the community.

By enabling data transparency, payers and providers can work together to improve outcomes for high-risk populations – and also to prevent patients/members who can be impacted from slipping through the cracks, which benefits everyone.

Rather than battling over custody of the data, by improving transparency payers and providers can identify opportunities to work together to deliver care management programs that improve the outcomes for individuals and populations – a huge win for all involved.


Working as a Team

                By adopting a mindset of collaboration to reach larger goals, payers and providers can engage patients/members more effectively than either could alone. Once they identify those patients/members who score highly for impactability and intervenability, payers and providers should work together to ensure patients/members understand and adopt the strategies that will help them become healthier and lead happier, more productive lives.

                When patients/members see this level of collaboration, it will reinforce the need for their active participation in their own care. Not only to improve their health but also to lower their financial stake, particularly if they have high-deductible health plans.


Incentive to Join Forces

                The healthcare industry has changed drastically over the last few years. Given the current political climate, there is a good chance more changes will occur – even if we don’t know the direction they will take.

What we do know is payers and providers share more common interests than they have in the past. The reimbursement model that incents providers to keep patients/members healthy rather than focusing on treating them when they are sick or injured meets the criteria for good healthcare as well as fiscal responsibility. Which means it is likely to remain.

                It’s time for payers and providers to break down the traditional barriers that have kept them apart and begin a new era of collaboration. Together they can accomplish more than either can separately.


Rose Higgins is the North American President of SCIO Health Analytics.