Innovation & Insights

The common language of value-based care: Why payer-provider partnership matters

03 May 2024

Access to supportive, high-quality providers is a key component of a positive healthcare experience. However, as physicians face workplace challenges including burnout and understaffing, they need the support of the whole healthcare ecosystem to continue providing high-quality patient care. Health plans can help by implementing a model of value-based care, where physicians are paid based on the quality of the care they provide instead of the number of appointments and procedures, benefitting patients with improved health, more care options, and lower costs.

Providence Health Plan (PHP) President and CEO Don Antonucci joined payer and hospital system leaders at the Becker’s Hospital Review 14th Annual Meeting in Chicago to discuss how payers and providers can work together effectively in value-based care contracts. The panel, titled, “Creating Value in Value-Based Care: A Conversation Between Payers and Health Systems,” featured Don alongside Ven Mothkur, MD, BlueCross BlueShield Illinois’ Senior Strategy Consultant of Key Provider Contracting; Tom Grote, CEO of Banner | Aetna; and Jennifer Lavoie, RN, CPC, Rush University Medical Center’s Director of Revenue Cycle Integrity. Becker's Healthcare Associate News Director and Editor Jakob Emerson moderated the conversation.

Read on for insights on how PHP works closely with providers and health systems to create seamless, supportive healthcare with a few simple ingredients in value-based care: clear communication, support for providers, and a focus on the patient.
 

Common language between payers and providers

“The language that we speak, the words that we use – we're talking past each other many times. Providers talk a very different language than payers talk… we have an opportunity in healthcare to bridge many of those gaps.” - Don Antonucci

As a provider-sponsored health plan, PHP has always been tied closely to the Providence health system, allowing the two to work closely together. This relationship has shown how prioritizing partnership and communication can help the healthcare industry thrive.

For example, Don noted the importance of speaking one-on-one with doctors or hospital workers. A patient’s care team can determine the services a patient truly needs and why, helping facilitate the payment process and necessary approvals to get the care. Creating a culture of effective communication and mutual understanding helps make this a positive experience for all involved.
 

Make providers’ lives easier

“The provider experience is really important now, given what we're seeing with physician burnout and the opportunities to use technology to help reduce workloads and hopefully help providers more. Because if you get that provider-patient relationship connected and strong, that's the real unlock that we need in healthcare.” - Don Antonucci

Nurses, doctors, surgeons, and all care providers are experts in caring for their patients. However, their roles require tasks beyond patient care, including note-taking, documentation, and payment processing. Don encouraged payers to consider the provider’s point of view to simplify their responsibilities and ensure they have more time and energy to devote wholly to patients.

For example, payers can closely guide physicians to get the right authorizations for the care they prescribe. Payers have the important role of facilitating and navigating healthcare benefits between members and their providers, and striving to do it effectively and quickly is key to getting patients the right care at the right time.
 

Patient-centric partnership

“If you're coming from the intent of access, affordability, quality, and experience for the members and the patients, and for the providers themselves, we're going to get to a better place.” - Don Antonucci

Though payers and providers play different roles in supporting communities’ health, their end goal is the same: to ease the way for patients and help them live healthier lives. An example of this work happens within Medicare Advantage (MA) plans, which prioritize value-based care for aging adults.

PHP focuses first on quality and experience in MA, ensuring members understand the care available to them and setting high standards of care for chronic conditions like diabetes. Providers help in these efforts by sharing data and their takeaways from working in these value-based care contracts, as well as their patients’ experiences, any barriers to care they encounter, and what they need most from their care. This motivation for a common goal drives positive change in healthcare.
 

Wrapping up

Thank you to Becker’s Hospital Review, fellow healthcare industry leaders, and the panelists and moderators who joined in discussions at this year’s Annual Meeting. As we reflect on the wealth of learnings, we look forward to continuing these conversations, finding innovative ways to partner, and taking action to ensure whole-person health for all.