SOLUTION PROVIDER Q&A
Bridging the Gap Between Payers and Providers with Behavioral Health
What had been predicted for decades is fi nally happening: payer and provider organizations are collaborating in the context of value- based contracts, especially risk-based ones. As incentives become aligned in value-based healthcare, payer and provider executives are navigating a new world, with data-sharing a key focus of the collaboration. What’s been working and what hasn’t? Participants will discuss what’s been learned so far, and what lies ahead.
The traditional lines between payers and providers are shifting, as more and more providers enter alternative payment models (APMs) and take on population health management and care management as core functions. How do you see the relationships between payer and provider organizations shifting in the next
couple of years? Providers will feel the fi nancial impact of COVID-19 long after the public health crisis subsides, which is why we’re seeing an overall shift towards more at risk-models. This fi nan- cial pressure and a new care environment will require a different approach to payer relation- ships. Providers in risk arrangements today may not be able to achieve performance in the current landscape which will impact value- based contracts (VBCs) and ultimately create a second wave of fi nancial burden. Hopefully, we’ll start to see a greater level
of expectations and demand for providing truly whole-person healthcare as well as greater accountability and reporting on associated measures. Some programs, such as CMS Innovation or CPC+ are already starting to pave the way. Additionally, providers are responding to the crisis and adopting tech- nology that is delivering effi ciencies, broader access to care, and more intelligence which should help them transform their business and create new ways to generate revenue, take advantage of new risk models, and ultimately fi nd success in a post-pandemic world.
The level of cooperation between payers and providers is changing as well. Where do you
see the main areas of potential
cooperation? This is where data comes into play. We’re see- ing a lot of mergers, partnerships, alliances between these two entities as they see ways to disrupt the fracture between payers and providers through the use of shared data to ultimately drive better outcomes. The sharing of data, resources, and potentially savings means both groups can attain better insight into care trends, social determinants, behav- ioral health - they need to coordinate care and leverage expanded care communities - and ultimately deliver more holistic support to keep costs down with improved quality and outcomes.
Data-sharing has already become a major focus of collaboration. What are the biggest challenges and opportunities that are emerging with regard to data- sharing between payers and
providers? One challenge we’re seeing is how a lack of understanding around data standards and regulations, be it HIPAA or 42 CFR pt 2, is causing organizations to be more hesitant to share and collaborate around data. That’s on top of the already existing issue of vari- ous EHRs and data systems preventing the adoption of a universal data system that could benefi t all key stakeholders in the care con- tinuum. Ultimately, it’s not enough to know when and where we can share data but how to actually ingest it, how to use it within mul- tiple systems, and how to exchange it without compromising security.
What are some of the key lessons that the leaders of hospitals, medical groups, and health systems are learning right now that will provide templates and lessons learned for others going
forward? First and foremost, we can’t treat medical con- ditions in silos. There exists an alarmingly high rate of co-occurring mental health and SUDs with chronic health conditions; so to treat the medical conditions in isolation will not improve quality or decrease cost. Provider
Chris Molaro CEO NeuroFlow
teams must be enriched with the necessary resources to treat patients holistically if we want to make a dent in improving the quality and cost of care. Using technology to pinpoint interventions, create better access, and deliver more holistic care enables them to perform better in VBCs and ultimately achieve the quadruple aim.
How quickly will the collaboration accelerate in the next few years? Will the landscape around APMs and payer-provider collaboration be very different three years from
now? This won’t happen overnight. We’ll see a gradual shift over time that won’t necessar- ily represent universal adoption, but enough of the payer mix that providers cannot ignore it. Adoption will be accelerated by the fi nancial situation some of these systems are experi- encing - to survive, they will need to rapidly transform their business. Payers and providers who are adopting clinical augmentation tools, like NeuroFlow, to improve the effi ciency and performance of their provider organizations will more quickly enhance the bidirectional trust and enable organizations to more will- ingly move into risk arrangements.
Sponsored Content
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MARCH/APRIL 2021 |
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