What's your piece of the payer-provider puzzle? (05-30-18)

What's your piece of the payer-provider puzzle?

By Heather Grimshaw


It’s easy to get mired in assumptions, stereotypes and misunderstandings when you work in health care. Extricating yourself from that mindset can be difficult yet essential to true health care reform that allows care teams to deliver integrated behavioral and physical health and communicate with data that encourage health plans to sustain it.

That requires true partnerships between representatives from health plans (payers) and health clinics (providers) built on honest and open communication between people, who have had tense relationships that center on cost and payment.

That is slowly changing with Multi-Stakeholder Symposiums (MSS) hosted by the Colorado State Innovation Model (SIM). The meetings put payers, providers and practice coaches around the same table to talk about health reform, different approaches to team care and data that helps providers show a unique value in the market. SIM is a federally funded, governor’s office initiative that will help 25% of Colorado primary care practices and community mental health centers integrate care and test alternative payment models.

Altering perspectives
At the April 26 MSS, about 60 health care professionals participated in a scenario-based game that relied on group discussion and collaboration for success.

Attendees, some of whom traveled from metro Denver to Grand Junction, received pieces of paper with images and told they could describe (not show) it to other attendees to decipher how the images fit together to tell a larger story. Some attendees were participants; others were observers. Most agreed it was awkward to begin with, intriguing to figure out the bigger story and very similar to the work they do to reform health care with funding from SIM.

The game, which lasted about 30 minutes, prompted questions, the formation and dissolution of groups with similar images or what seemed to be a progression of the story and a few people, who suggested new ways to find a solution. Slowly a story began to emerge and attendees reshuffled to align with a narrative that included a pilot, a plane, a toy factory and people receiving mail on a beach.

“Each group didn’t know how they fit together until the next group connected to them,” said a practice representative during the debrief period after the exercise.

Several heads nodded in agreement.

“We only have one perspective; one piece of the picture most of the time,” said a health plan representative, “but it takes a lot of people and a lot of collaboration to make this work,” she added with a nod to the exercise and health care reform efforts.

“It was a real leap for all of us to find the groups that we belonged to,” said a health plan representative. “You had to take your little earth view and figure out how it connected with everyone else. That connection was hard. It was a leap.”

Finding those connections, is one of the most rewarding aspects of reforming health care in ways that improve patient outcomes and lower or avoid unnecessary costs, said four practice representatives who shared the work they’ve done through SIM.

 “It’s great to have another perspective when we feel like we’re hitting a brick wall,” one SIM provider said about behavioral health providers, with whom he consults about shared patients. “It’s rewarding, it’s the right thing to do and it needs to be paid for,” he added.

One health plan representative asked what he had in mind. “We’re looking for creative solutions that support this holistic model you have,” she said. “We’d like to hear your suggestions.”

Recognizing different perspectives—or earth views—helps initiate different conversations about sustaining health reform efforts that improve health outcomes and reduce costs. The key is getting to the negotiation table with data that shows how care team efforts improve health, and the ways in which practice efficiency expands access. SIM MSS events are one way to foster this new dialogue between providers and health plan representatives. The story will continue Sept. 27 with the third and last MSS for the year.