Whole-person health: A SIM blog

Redefining health care partnerships together: Payers and providers share successes (09/30/2018

Power dynamics are important in all types of business. In health care, the power dynamic between health plans (payers) and health care providers has historically been described as imbalanced, which has created tension and frustration. Yet some providers are evening out the playing field with payers using practice data to show how their care teams are improving patient health while avoiding or reducing unnecessary costs.

The shift from a traditional health care environment in which providers are paid for services delivered (volume) to one that rewards value or better health outcomes, has exacerbated historical tensions because success with new payment models requires providers to retool approaches to patient care, invest in new or expand care teams and ensure that data proves their unique value. That takes time and money. There is also confusion over how payers define quality and value and which payment models will sustain the delivery of integrated or whole-person care.

“We keep hearing that health plans want more value and want providers to take on more risks,” said a health care provider, who participated on a panel during the September Multi-Stakeholder Symposium (MSS). “We are trying to work together on how we define value and quality so that we can come up with a common definition for that.”

The key word in that sentence is together.

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Proving your unique value is a key component to success in alternative payment models (APMs) that reward the value of health care delivered. It sounds like a simple equation but there is nothing simple about helping providers prove that what they are doing in practice helps improve patient outcomes and reduce or avoid unnecessary costs—two keys to success in APMs.

Yet data shows that practices engaged in the Colorado State Innovation Model (SIM), a federally funded, governor’s office initiative, are poised for better success in APMs because of practice transformation work funded by SIM. The initiative includes hundreds of practice sites, four community mental health centers and investments in local public health agencies that cover 31 counties and a new workforce to improve connections between providers and community resources.

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