September, 12 2011
By:
HIMSS Patient-Centered Roundtable The following is a summary of a selected monthly meetings of the HIMSS Patient-Centered Payer Roundtable. Each session has a featured speaker and is focused on a specific topic. Session recordings of each meeting is available on the HIMSS Patient-Centered Payer Roundtable website at no cost.
Building a Consumer Centric Collaborative Platform – Healthcare Reform Is a Team Sport: Has Payer/Provider Collaboration Finally Arrived?
Presented by Janice W. Young – Program Director, Payer IT Strategies, IDC Health Insights
June 16, 2011, and July 21, 2011
Janice W. Young discussed building collaborations between payers and providers in the Post Reform Era. She led an engaged dialogue with members of the Roundtable on how payers and providers can leverage common challenges of increasing access, reducing costs, improving outcomes, and building health and wellness to find new ways to collaborate.
The two session discussions also considered consumer engagement, emerging clinical models, evidence-based programs, aligned payment and incentives, and technology opportunities as key collaboration areas. In the first webinar, Ms. Young elaborated on current industry research on consumer requirements, including details on the rising consumer IT literacy rate, and expectations on healthcare choice, efficiency, accessibility, and affordability.
Ms. Young also provided a “post-reform collaboration platform template” illustrating the positions and relationships of all the key stakeholder groups (i.e., consumers, employers, ACOs, HIEs, medical homes, and payers), and the processes and IT applications that are enabling these groups to better collaborate and share information. The discussion included key challenges with this template, including the lack of historical collaboration between payers and providers, and a lack of general “best practices” for widespread collaborative models.
Given the identified challenges in the template, Ms. Young identified the best opportunities for collaboration, including:
• consumer engagement
• clinical care
• health and wellness
• process automation
• information/data
• outcomes based payment
• payment/revenue cycle automation.
The second session continued the discussion by providing an outline of key health reform milestones and considerations for commercial health plans. The participants discussed how a common model for care collaboration among key stakeholder groups could best be developed. Ms. Young suggested that key building blocks for collaboration include a federated data model for health information exchange, the possibility of future government regulation, and the emerging practices of ACOs. The challenge will be translating successful models from one environment to another given the differences between organizations’ management, financial, governance, and environmental factors.
Ms. Young illustrated a list of key areas for IT collaboration between payers and providers, including the following:
• consumer benefit product selection tools
• network management analytics
• sales analytics
• clinical analytics
• customer service and retention analytics.
Ms. Young concluded the discussion with an illustration and discussion of specific IT areas where there are disconnects, redundancy, and existing collaboration between health payer and provider investment areas. She provided a table of various health IT application areas, and noted the existing business model challenges to building a “consumer centric collaborative platform.”
