Healthcare payers and providers are still fighting along the borders that separate one another. Initiatives such as pay-for-performance—a payment model that rewards clinicians, hospitals and medical groups for meeting certain performance measures for quality and efficiency—drive massive gaps between payers and providers. Providers religiously cling to patient health information as they strive to make financial gains as a reward for a patient’s health outcome. Payers, in the meantime, are defending patient finance records as pay-for-performance can hurt the bottom line when a patient’s reimbursement process is not properly handled. Aggressive defense of key data sets, lack of communication and minimal collaboration hurts both sides—most of all, it hurts patients.

A clear, collaborative model must be adopted for payers and providers to deliver a better patient experience

When payers and providers don’t collaborate, the patient needs to take the extra initiative and burden of forcing the communication between both sides—dealing with multiple bills, different opinions on their outcomes and, sometimes in extreme cases, dealing with hidden costs payers or providers were unaware of. This is unacceptable. As time goes on, payers and providers must be united. Once aligned, this hybrid of information will lead to better health outcomes, an enhanced care mode and clear financial wins for both sides. A clear, collaborative model must be adopted for the two sides to join together to deliver a better patient experience.

According to Andrew Underhill, a chief technologist at Systems Made Simple:

This strategy enables informed care decisions and also reduces the likelihood of duplicative or unnecessary tests. It also limits the reliance on patient memory and perspective, ensuring care decisions are based on facts rather than educated guesses.

Andrew Underhill, chief technologist at Systems Made Simple, on creating a clear collaborative model

Payer and Provider Collaboration Is a Necessity

Payer and provider collaboration and vertical integration model from BCG

An integrated system that allows payers and providers to collaborate without barriers is becoming a necessity. Many payers and providers do not share the same infrastructure, identity information or mobile strategies—yet both sides may share the same patients. A secure, integrated hub for real-time collaboration, analytics, secure messaging, and communication over health outcomes builds a strong bond between payers and providers, helping to structure governance and lead to streamlined payment arrangements.

Collaboration at this level will benefit providers who can now share critical information to payers. And, in reverse, payers can provide ways to improve the overall quality of a patients health long-term. Creating a singular entity for each side of the healthcare model to work cooperatively supports an ideal alliance to advance the quality and cost of care.

In a recent study completed by HealthAffairs, “Collaboration between Aetna (payer) and NovaHealth (provider) focused on shared data, financial incentives, and care management to improve health outcomes for approximately 750 Medicare Advantage members. The patient population in the pilot program had 50 percent fewer hospital days per 1,000 patients, 45 percent fewer admissions, and 56 percent fewer readmissions than statewide unmanaged Medicare populations. NovaHealth’s total per member per month costs across all cost categories for its Aetna Medicare Advantage members were 16.5 percent to 33 percent lower than costs for members not in this provider organization.”

Accessibility and Transparency Is Critical

Payers and providers need a plan for ensuring transparency. The targeted quality measures that providers and others are performing against must be made available to all participants involved.

The accessibility of this information and shared transparency among all entities ensures:

  • Performance measures are met and that everyone gets paid appropriately in value-based systems
  • Both sides get their proper financial returns and satisfaction scores
  • Payers and providers have an open dialogue and share critical information that would be lost in other forms of digital communication
  • Silos come down, creating trust among organizations that have been blind to each other
  • Cross-collaboration in each stage of patient care, providing returns that improve population health

Improving Patient Health Outcomes

Using aligned data from both payers and providers allows communities to be created around a patient’s chronic disease or illness. Many times, support groups are built around these ideals but are disconnected from both the provider and patient. Due to a lack of social resources, patients are unable to fully comply with treatment plans, follow provider instructions, return for a follow-up visit, and ultimately, experience good health outcomes.

Patients will refuse to join these groups as they are just “another patient portal” that they need to participate in. Using data leveraged from the provider, however, payers can create strong social communities that address a patient’s issues before they join. Places like MyMedicareAnswers drives improvements in patient satisfaction, availability of information and treats the patient with respect.

Payer, provider and patient collaboration is key to improving patient satisfaction and delivering better health outcomes

A New Era

The time has passed where payers and providers can work independently from one other. Both sides must unite digitally in a socially collaborative space—a space that connects clinicians to their patients’ payers. Healthcare providers can find peace and mutual understanding after a long war over fragmented policies and reimbursement measures. Payer, provider and patient collaboration is key to improving patient satisfaction and delivering better health outcomes.

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Frequently Asked Questions

We’ve got your back every step of the way!

How do you build employee engagement?

Here are 4 top tips to build employee engagement in your workplace:

  1. Create a positive work environment.
  2. Encourage employees to collaborate and connect.
  3. Use an employee intranet portal to increase internal communication.
  4. Encourage open communication.
How do you determine which employee engagement solution is right for your business?

There are many employee engagement tools available. Jive offers an industry-leading intranet platform that empowers employees and increases engagement.

How do you measure employee engagement?

Here are 3 easy ways to measure employee engagement:

  1. Conduct an employee survey.
  2. Use HR employee engagement software.
  3. Introduce an incentive-based strategy.
How can employee engagement strategies impact the culture of your organization?

An engaged employee is a productive employee. The more engaged an employee is, the lower the turnover rate will be for your company.

Why is employee engagement important to company success?

Employee engagement has a direct impact on lowering employee turnover rates. HR leaders should focus on increasing engagement in order to shore up employee retention and boost productivity.

How do you know when your employees and managers are engaged?

Answer these questions to know if your employees and managers are highly engaged:

  • Are your employees and managers absolutely clear about the company’s core values and goals?
  • Do they actively communicate and collaborate on your company intranet platform?
  • Can they see how their contributions are adding value to the company’s success?
  • Do the managers have good leadership skills?
  • Do employees have access to all necessary tools?
  • Are employees happy and motivated to work?
What is an HR employee engagement platform?

An HR employee engagement platform in an employee engagement solution that helps organizations increase job satisfaction and improve employee retention.

Why do most engagement strategies and initiatives fail?

Most engagement strategies lack a sense of employee empowerment. When employees feel powerless, they lack confidence in the organization, and their involvement decreases with time. At Jive, we offer an interactive intranet platform that empowers employees to communicate, share files and get work done. With Jive, employees feel empowered, connected, and most importantly- engaged with their work.

How do you define engagement?

In an organization, “engagement” is an employee’s emotional commitment to the company and its goals. Without engaged employees, organizations can never be successful. At Jive, we offer powerful collaboration software to help employees connect, collaborate, engage quickly and help businesses achieve peak productivity.

Can our company add our groups to the Jive intranet platform?

Yes. At Jive, employees can create groups easily in our employee social network. This helps everyone connect, collaborate and share content with specific people and get responses immediately. Using groups is convenient, collaborative and cost-effective.