Payer-Provider Collaboration: The Cure for Provider Abrasion

Kangana Mehta
Wed 16 Aug 2023
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In part 1 of our series on payer-provider collaboration, we talked about the challenge of data silos. In part 2, we’ll look at the challenge of provider abrasion and its cure: meaningful payer-provider collaboration based on shared and timely access to data.

“Abrasion” is one of the most persistent complaints that physicians have with payers. They might not use the word, but when they talk about difficulties they face in navigating portals, entering data, searching for information, obtaining authorization, processing claims, or proving they’ve hit payment incentives, they’re pointing out how much sand there is in the gears of the American healthcare system, and calling attention to the occasional stick in the wheel.

The solution for reducing or even eliminating that abrasion is not less connection between payers and providers, but functional collaboration based on real-time exchange of clinical data that is mutually trusted and relied upon.

It’s not like physicians and payers don’t spend time working with one another. In fact, a 2011 Commonwealth Fund study found:

  • Physician practices in the US spend $82,975 per physician per year interacting with payers
  • Nurses and medical assistants spend 20.6 hours per physician per week on administrative tasks related to health plans
  • Very little time was spent submitting quality data

The intensity of that administrative burden is exacerbated by the data challenges mentioned above. What’s missing is fluid connectivity; the kind that enables meaningful collaboration. Based on extensive experience, providers—especially in value-based arrangements where the provider is at risk—worry that the clinical data available to them may be past its prime or that relevant data might be missing.

They might be told, for instance, that they are responsible for a patient’s care gaps when that patient has no upcoming visit scheduled. Since they’re on the hook for those gaps, this forces them to chase the patient down and schedule a visit.

But is that information even accurate? The data is already six months old. This puts them in the position of tracking down additional clinical data for that patient, and clicking and searching through multiple systems just to verify what care has been provided and whether it has been effective.

According to the Healthcare Financial Management Association (HFMA), the average number of payers that providers deal with is 17. If the provider is working with 17 different payers, that’s 17 different portals or systems that must be scoured to download care information, all somehow fitting into the normal day’s workload. In the real world, most of us are used to the adage “trust but verify.” But that’s an awful lot of verification for very little trust … and a lot of abrasion, too.

Another challenge is that providers are often required to document patient encounters in several systems. Does that data actually reach the payer? Providers can be forgiven for wondering when they have to re-enter or reprocess claims and outcomes. This adds to their risk of burnout and reduces their time with patients.

If providers are going to engage confidently in value-based contracts, they need to have direct influence over their performance. Real collaboration is impossible when providers lack ready visibility into the data they need when they need it.

The biggest advantage of a C-CDA (Consolidated Clinical Data Architecture) is its promise to share clinical data and information between providers and payers in real time. That enables payers to assess and run analytics using real-time data, and it ensures the data accessed by providers is fresh, has integrity, and is trustworthy.

C-CDAs are limited, however, by the system they function on. A shared enterprise data platform that provides a 360-degree unified record for every member, spanning clinical, claims, HIE, ADT, and other types of data sources, increases the ease of data sharing and data access. Such technologies also assist payers and providers in managing patient care across multiple settings and systems, including enabling support for integrated, insights-driven care coordination, medication management, and patient education.

When providers learn to trust their data (and their access to it), their feelings of administrative burden and burnout decrease, and they can turn more of their limited attention and resources to patient care and engagement. In turn, payers can have more reliability on providers’ ability to engage patients and close care gaps for members, improving overall scores.

That reduces provider abrasion, lessens the risk of burnout, and frankly, ’s a win-win for every stakeholder involved: the payer, the provider, and the member/patient.

How Can Innovaccer Help?

The administrative complexity created by multiple documentation requirements adds to physician fatigue and takes time away from clinical care. Previous attempts at payer-provider collaboration were often unsuccessful. One of the reasons for not succeeding has been the lack of a data platform that provides access to a unified patient record. Provider abrasion can’t be solved fully until there is more open data sharing. The Innovaccer Platform drives collaboration and connectivity among payers and providers with the industry’s Best-in-KLAS data platform for value-based care. By unlocking the power of data, the Innovaccer platform helps providers and payers with personalization and data access. The robust data security and infrastructure setup enables a pre-configured security hierarchy and user profiles to ensure appropriate data access for payers and providers.

Advanced workflows help providers with timely access to prospective gap-in-risk and gap-in-care chase lists and integrated care management functionalities to address high-risk patients. The workflows also enable full-fledged opportunity identification and hot spotting with high confidence and performance trend reporting and monitoring for payers.

Providers can utilize Innovaccer’s flexible predictive modeling and self-serve analytics tools for insights into sophisticated user-based reports and alignment across different patient segments (e.g., contract type, risk level, demographic). These tools also empower payers to use social vulnerability and other industry risk models and provide the ability to execute payer rules and algorithms.

96K+ providers across 70+ customers are a part of the Innovaccer network. The Innovaccer Platform can support payers, providers, and health systems in delivering rich outcomes through easy data sharing between these entities.


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Tags: Payer-Provider
Kangana Mehta
Senior Director, Growth Strategy, Innovaccer

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