Payer-Provider Collaboration in an Uncertain Environment
There is a lot of uncertainty in healthcare today. Health plans like to know what the risk is and manage the risk. And when that risk is uncertain, it is challenging to run your business in that environment.
Many plans saw a drop in claims in 2020. However, the low level of claims will not continue indefinitely. Now, health plans must prepare for what is coming. Yet, uncertainty remains. It is still unclear how many people put off routine visits, as well as emergency care, and how that will impact healthcare costs post-COVID.
In the Annual Payer Index Survey: 2020 Report from Altruista Health, a HealthEdge company, the majority of the 177 respondents cited improving member outcomes as the top care management priority. And when asked about the effects they see with members who delayed medical care, "Forty-two percent reported member lapses in care for chronic conditions, and 26 percent saw preventable poor outcomes due to lack of routine screenings."
Should health plans prepare for an influx of treatment? Will costs go higher than expected due to more emergency room visits or inpatient stays? Or if it will spread out over time.
Health systems and providers have felt the most impact from the financial ramifications of COVID-19. Many plans are focused on payer-provider collaboration, stepping in to see what they can do to collaborate with providers and ensure they can do what they can to keep their businesses moving forward.
Health plans required flexibility to design new benefit offerings that support their providers and serve their members to implement these collaborative solutions. For example, the pandemic led to a willingness to embrace technology across the healthcare ecosystem. Things like telehealth, which were not pervasive before the pandemic, are now widespread and will continue to be used post-pandemic.
Although they are national plans, at their core, their mission is to make communities healthier, lower costs, and improve access to quality care. Healthier members lead to a better business, and national plans have proven to be part of that solution.
Health plans with an agile and flexible system have a competitive advantage. The modern architecture and unique design of the HealthRules Solutions Suite lends itself to a controlled and comprehensive modeling of new product designs and provider pricing methodologies.