New Research: Why Payer-Provider Collaboration Matters—and How to Enable It

It’s nearly unanimous—providers want to work more closely with health plans to better serve patients. Amid a revolution in healthcare, with government mandates, evolving customer demands, and new potential healthcare alliances driving rapid-fire innovation, providers and plans alike realize that they can’t go it alone anymore.

Payer-provider collaboration has thus become a top priority for 2022. We recently surveyed 100 executives from hospitals and health systems with responsibility for payer relations across the U.S., and 92% of them said they want greater collaboration with health plans. That’s because they see significant potential benefits, including enhancing the patient experience. However, only 37% of respondents are collaborating with health plans around online experiences today.

Health plans and providers share a common goal—lowering healthcare costs and improving health outcomes—but the path isn’t always clear due to misaligned incentives and competing priorities. Health plans are already partnering with providers on new models of care; now it’s time to extend that collaboration to make healthcare easier for people to navigate.

Here are three areas to consider that came through from the respondents in our survey:

  • Collaboration to improve the member experience. Providers say enhancing member-facing experiences online is one of the top three ways they can make the most difference for their patients. And the top area providers want to collaborate with payers to improve the patient experience is by delivering more consistency in user experience and data. Explore ways to make the data members access for decision-making—including pricing and providers, among other aspects—more accurate and consistent between your health plan portal and the health system website. Plans and providers have an opportunity to make healthcare less complex by improving the information members see and use.
  • Collaboration to maximize in-network resources. People don’t make health-related decisions based solely on provider name, specialty, and location—that’s table stakes. Unfortunately, healthcare consumers often have to look for in-network providers in one place and  then look elsewhere for additional insight into which provider is the right fit for them with information like their approach to care. By partnering with providers, health plans can deliver richer data and insights to help people find their provider match while also meeting utilization management goals; together, you can help ensure that people get high-quality care from a provider that meets their unique needs and preferences.
  • Collaboration on value-based care. Everyone wants better health, at a reasonable cost. But while value-based care is important to health plans’ ability to manage costs, providers see significant barriers to moving away from fee-for-service models. More than half of health systems (55%) would like health plans to be more transparent about data shared for value-based care over the next 12 months. Align on goals with greater cost transparency and data sharing. This presents an opportunity to bring price transparency data into your provider partners’ workflows to support cost effective referrals.

Collaboration isn’t always easy, but there are a lot of ways to do it. Finding common ground is the first step. If you’re interested in learning more about the data or how our team can help facilitate greater collaboration between your health plan and your provider network to benefit members—send us an email and we’ll set up a time to chat.