The Evolving Payer-Provider Dynamic in US Healthcare

The Next Generation Healthcare Summit brought together a group of senior leaders of healthcare payer and provider organizations from June 13-15, 2018 at the Woodlands, outside of Houston Texas, to address key issues shared by their organizations. With many gains possible from payer-provider collaboration, there were lively discussions regarding shared challenges, solutions applied and case studies of successes. Participants gained many insights to take home, and understood many of the issues encountered by their organizations in making the shift to value based care and becoming data-enabled and data-driven were shared by others.

There were three main themes for the roundtable groups that met on the first evening:

-Customer Experience: payer-provider collaboration and consumer loyalty. Healthcare organizations are using data in a variety of ways to segment and identify individuals for engagement and intervention
-Clinical Decision support and the future of payer-provider decision making in a data-driven world.
-Data Analytics: gaining insights and developing an action plan based on a unified patient data set. Part of the collaboration challenge in both analytics and in driving decisions from data is aligning on the needed data points and their value to the intended outcomes.

Other interesting findings include applications for artificial intelligence in operational use cases, assessing length-of-stay through analytics, and using a public-private collaboration to connect via a shared data infrastructure to exchange data from and between healthcare providers, pharmacies and other traditional and non-traditional healthcare ecosystem stakeholders.

Author: Greg Caressi