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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