Marc Scher: Making the right moves forward for payer-provider collaboration

If innovation is key to moving forward as an industry and as an organization, so is the ability to nurture strong relationships. It’s a skill that is crucial to navigating payer-provider relations, where the stakes can mean the difference between a patient being able to access care locally and having to travel long distances for treatment.

This past summer, HFMA dug deep into the state of payer-provider relations, surveying leaders across the country and conducting interviews with representatives from health plans and health systems of all types. One of the themes from this report, set to be published soon, is that payer-providers are stuck in a zero-sum game: “I win, you lose; you win, I lose.”

“I think the cure to that is deeper, longer, more intentional partnerships between payers and providers,” Sachin Jain, MD, MBA, CEO, SCAN Health Plan, told HFMA.

So how do we get there?

One opportunity is for payers and providers to sharpen the focus on personal accountability at the consumer level — together.

By every standard, the United States is a wealthy country. However, a large portion of our citizens are overweight and have other unhealthy habits, like lack of medication adherence. Furthermore, we have the lowest rate of life expectancy at birth and the highest rate of avoidable deaths, according to a Commonwealth Fund report.

And as sales of GLP-1 antagonist drugs originally intended to treat diabetes balloon to new heights, we know that a percentage of those prescriptions are obtained by people who want an easier answer to achieving a healthy weight.

How much more could we save if we took better care of ourselves?

If payers and providers are committed to value in healthcare — providing both high-quality care and patient experiences at a low cost — we must come together to help the people we serve stay healthy, with an understanding of the challenges they face in doing so. We also must focus on teaching children the behaviors they need to stay healthy, including how to practice healthy eating, and help provide resources to support healthy behaviors, such as programs that ensure families have access to nutritious foods.

These are efforts that have a long timeline for ROI. Among children, we might not see the full impact for 20 to 30 years. But there are steps we can’t afford not to prioritize — together. This collaboration will foster long-term relationships and a path to better health — something we all want to achieve.

The HFMA report on payer-provider collaboration will be available online in the weeks ahead. In it, you’ll find several takeaways for building stronger payer-provider connections.

Changing the dynamic around payer-provider relations won’t be easy. Nothing worthwhile ever is. But it’s necessary for establishing a better basis for mutual success.