3 Trends in Payor-Provider Collaboration and Healthcare Delivery

How is the healthcare delivery system and payor-provider collaboration likely to change following the COVID-19 pandemic?

AMGA hosted Dr. David Nash, Founding Emeritus of Jefferson College of Population Health, and Saurabh Kumar, Chief Financial Officer of UnitedHealthcare, in a free webinar to share their insights as providers and payors. The webinar, “The New Normal: How Will Providers and Payers Adapt,” was moderated by Puneet Maheshwari, CEO of DocASAP.  

“This is a very unique time. We are right now at the cusp where the new normal is getting defined,” Maheshwari said in the webinar’s introduction. “Most researchers are showing macro trends around contact-free care delivery, democratizing patient data, and the next generation of value-based care.” 

Healthcare Will Move Into the Home

Telemedicine has evolved from a novelty to a necessity during the coronavirus pandemic. An estimated $250B of healthcare spending could be virtualized, according to Mckinsey. 

Both panelists agreed that virtual care is a permanent part of healthcare’s new normal. It falls on payor-provider collaboration to ensure telemedicine remains viable.

“I do think it is a genie out of the bottle now,” Kumar said, echoing the sentiments of CMS Administrator Seema Verma. “Practically, I don’t see how we go backward, especially with the uncertainty that continues to pervade all of us from a COVID-19 perspective. What payors and providers need to do is figure out how to make this change sustainable.” 

Dr. Nash shared that Jefferson College conducts upwards of 20,000 online visits each week. From his perspective, telemedicine could be the start of an industry-wide paradigm shift in care delivery. In addition to increasing patient access for marginalized populations and protecting patients and providers from COVID-19 exposure, healthcare services could move out of expensive medical facilities and into patient homes. 

“I think this is the beginning of a movement to get all care as possible into the home,” Nash said. “Beyond home health, I think we’re going to see acute care and chronic care in the home. [Home health companies] are all a part of this movement to get care out of the super expensive four walls of the hospital where everything has to be cross-subsidized and into the home where it’s safer.” 

Democratized Data Will Enable Payor-Provider Collaboration

The COVID-19 crisis has proven that scattered patient records and siloed health data complicates care delivery and hinders public health. During March and April, healthcare organizations struggled to share information and collaborate while the pandemic raged through their communities. CMS also delayed the rollout of its latest Interoperability and Patient Access rule due to the pandemic. 

Dr. Nash said that the healthcare information exchange in Philadelphia has proved invaluable for tracking PPE supply, COVID-19 testing results, available ICU beds, and potential outbreaks. He views data democratization as a progression from electronic health records, to a registry of particular patient populations, to predictive analytics, and then to artificial or augmented intelligence.

“Data is like blood flow in a physiological system, but data by itself without actionable information is not usable,” Nash said. 

Kumar agreed that data collection should be grounded in a problem or question. Given the variance in health issues from community to community, Kumar suggested that healthcare organizations work together to decide what data needs to be collected to achieve their specific goals. 

“While we do have a variety of evidence-based medicine available, the reality is there is a huge variation in the type of care delivered at a local market level,” Kumar said. “That gets reflected in the fact that hip replacement rates in certain parts of the country are 2-3x more than in other parts of the country, even when adjusted for risk and mortality. That is a wonderful problem for all industry participants to get together and solve.” 

Capitation Will Gain Traction

The future of value-based care looked bleak when 56% of ACOs said they would leave their risk-based payment programs. However, both speakers believe value-based care will evolve and gain traction in healthcare’s future. 

According to Kumar, the industry needs additional infrastructure for value-based care to grow–and that starts with revisiting risk. 

“The idea here is to move towards a shared responsibility around the patient between payors and providers and moving to real risk,” Kumar said. “If you look in the contract, the percentage of dollars at risk are not really meaningful. The opportunity for the physician to have different behavior is really diluted by the time everything is said and done.” 

Meanwhile, Nash views coronavirus as the “death knell of fee-for-service.” He believes the ‘payvider’ and capitation models will catch on as payors and providers enter new joint ventures. Payors like Blue Cross Blue Shield North Carolina are already creating new programs to speed up the adoption of value-based care and support providers via monthly capitation payments.

“We can’t deny that physician groups that were taking capitation pre-COVID are looking pretty smart right now,” Nash said. “They got their check every month to maintain or improve health. They’re not on a utilization model. That model is dead, deservedly so. I think the last 90 days proved to most practitioners, especially capitation primary doctors, that they are on the righteous path. There’s no turning back now.”

Access the On-Demand Webinar

Learn more about payor-provider collaboration and healthcare delivery under the new normal in the full on-demand webinar. In this webinar, our speakers discuss:

• Telehealth and new care delivery protocols
• Payor and provider collaboration – what will it look like?
• Digitizing access to care and its implications
• Democratizing patient data – how will it happen?
• Population health management considerations

Access the webinar here.