Value-Based Care Requires Payer-Provider Collaboration

Payers are increasingly incorporating social determinants of health (SDoH)— biology and genetics, individual behavior, social environment, physical environment, and access to health care and health insurance—into their members' health predictions and working together with providers and community resources to fill these gaps in non-clinical care.

However, we still do not have a standardized way of collecting this data, which creates challenges. Furthermore, although it has been proven time and time again that aligning incentives between payers and providers improves care, some are still hesitant to fully collaborate. Thanks to the fee-for-service history, where providers depended on high-volumes, these two sides of the table can often be at odds.

When it comes to value-based care and SDoH, payers and providers benefit from breaking down silos, collaborating, and sharing information, but the industry continues to work in silos. To address these social factors and improve care, data must flow freely between payers, providers, members/patients, and community resources.

Sharing data and analytics can help with SDoH and understanding how it impacts high utilizing members. Bringing data systems together will improve payer-provider collaboration, enable better information exchange, improve quality of care, reduce costs, and provide much-needed transparency across the healthcare ecosystem to manage patient populations.

Health plans must have the tools and technology to collect the SDoH data, share the data, and develop and agree to Key Performance Indicators and take ownership of the scorecard that determines success. And, payers must leverage value-based models to encourage physicians to identify SDoH gaps and create goals or incentives around them.

Payers and providers who take a holistic, preventative approach to members' care make an enormous difference in an individual's health and well-being. To that end, SDoH are becoming as important as medical record information. While many payers are down the road with SDoH, the healthcare community in general still has much work to do. Continued partnerships with community organizations and other payers/providers will go a long way to address SDoH.

About the Author

Janet Barros

Janet Barros, Senior Business Development Manager, HealthEdge
Janet Barros is a seasoned healthcare business development executive with extensive sales and client management experience. Janet works closely with senior executives to identify their business objectives and provide the solutions and strategies that enable them to achieve their goals. She has an extensive background in digital health, payer, provider, and solution sectors. Prior to joining HealthEdge in 2018, Janet led successful revenue-generating initiatives at Influence Health, Premier Medical, and, most recently, Aptus Health.

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