Payer-Provider Relationship in a Post COVID Landscape

As the healthcare industry emerges from a challenging year following the unprecedented COVID-19 pandemic, payers are increasingly adopting new strategies to capitalize on the new trends in delivering healthcare services. While payers act as catalysts for driving a significant portion of providers’ income, the latter will have to revamp their relationship with payers since the healthcare industry may continue feeling the impact of the pandemic long after the health crisis abates.

In the post-COVID era, payers are evaluating the use of innovative strategies to deploy effective care management solutions for their members, considering both cost and convenience. Capitalizing on the trends that have been stimulated by the pandemic can also drive financial stability and integration. Both payers and providers will have to coordinate and adopt key industry trends to achieve success in the new normal.

Let’s have a look at some payer-provider strategies that will prove to be revolutionary in the post-COVID landscape.

Diversifying Telehealth and Other Remote Care Services

Due to the pandemic, consumer adoption of telehealth and other remote care services has skyrocketed. As per CDC’s research, the number of telehealth visits increased by 50% in the first quarter of 2020, compared with the same period in 2019. COVID-19 has provided much exposure to these services, triggering widespread technological adaptation in just a couple of months.

To facilitate remote care services post-pandemic, providers must coordinate with payers to add telehealth and remote care services to their contracts. They must understand the economics of telehealth, like costs for payer reimbursement and provider margins. To embed virtual health deeply into the care delivery system, providers should strategically transform their existing telehealth services into fully functional virtual health management systems. As noted by McKinsey, with the acceleration of consumer and provider adoption of telehealth and extension of telehealth beyond virtual urgent care, up to $250 billion of current US healthcare spending could potentially be virtualized.

Integrating Behavioral and Physical Healthcare into the System

The pandemic has intensified the integration of behavioral and physical healthcare services in primary healthcare settings. Access to mental and behavioral health care is imperative to the well-being of beneficiaries. In June 2020, 40% of adults in the United States reported struggling with mental health or substance abuse, according to the Centers for Disease Control and Prevention.

In the post-pandemic world, payers can coordinate with providers to modify the contracts based on the types of services providers perform like behavioral and physical health care services, collect and analyze more data, and reinforce the capacity of the behavioral health force.

Reinforcing Value-Based Payer-Provider Partnerships

The pandemic has disrupted the sense of normalcy in payer-provider relationships. As both payers and providers are looking for financial stability to combat current economic challenges, the opportunity for value-based payer-provider partnerships is escalating. Progressive risk-based care models could allow both entities to evolve and cultivate stronger financial positions.

Providers must step towards effective risk-based contracts to control the cost while maintaining the quality of care. To achieve this, providers will need to enhance their internal operating capabilities. These may include risk adjustments, quality and clinical programs, analytics, efficient care-network strategy, and physician alignment. Payers also need to bolster their operational capabilities to reinforce their partnership with providers. The elements may include efficient financial and administrative operations, timely sharing and reporting of data, transparent contracts, and effective financial reconciliation of VBC contracts.

Conclusion

As we enter a new decade with unusual challenges in the healthcare landscape, payers will need to reset and reinforce their relationship with providers. If aligned strategically, value-based care will reap greater economic stability. The key feature of integration of behavioral healthcare and expansion of virtual healthcare will be effective data management. Innovaccer’s Data Activation Platform enriches the payer-provider relationship by integrating data and improving care delivery using cutting-edge technology.

Find out more about our FHIR-Enabled Data Activation Platform and get a demo.