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.
Payer-Provider Collaborations
Presented by Emad Rizk, MD – President, McKesson Health Solutions
January 20, 2011
Emad Rizk, MD, discussed payer-provider collaboration issues. With consumers, employers, and the government exerting downward cost pressures against various upward cost pressures – such as from increasing rates of services utilized by an aging population, increased expenses from new and beneficial specialty biopharmaceutical and diagnostic innovations, payer requirements, and the economy – both providers and payers are struggling to maintain financial stability. Historic misalignment between providers and payers has resulted in episodic care, distrust, cookbook medicine, and high administrative costs.
There is now a fundamental need for payers and providers to work in alignment and in collaborative support of bending the cost curve while improving patient outcomes. Payers and providers should break the cycle of push and pull around these costs and align toward common goals: improved patient outcomes, reduced bureaucracy, increased efficiency, and lower costs.
Dr. Rizk discussed practical strategies for payers and providers to build true collaborations to improve outcomes and lower costs. The discussion included a dialogue around three key areas in which payers and provides must align:
1. Clinical. Identify the best treatments from evidence-based medicine and mutually determine appropriate care.
2. Economic. Agree on costs in advance, in detail and with full transparency.
3. Administrative. Create and use tools to diminish the administrative burden for all parties and increase efficiency.
Dr. Rizk outlined five steps that payers and providers should take to start down the road toward a new era of healthcare, and an additional five areas in which payers and providers should proactively engage.
