Value-Based Care and Digital Health Are Disrupting How Health Plans and Providers Collaborate on Patient Access
// By Jordan Pisarcik //
Most providers do not have a digital access strategy in place that accounts for health plan initiatives, but greater payer-provider financial alignment will accelerate the need for a coherent strategy.
Value-based care models are on the rise, and health care providers and payers are increasingly aligning to control costs while providing quality care. According to a recent report by Humana1, value-based care initiatives are proving to be more cost-effective than traditional fee-for-service models. By emphasizing quality of care and access to care, value-based care models can improve overall health outcomes and provide better patient experiences in the long term.
Value-based care requires providers and payers to form an integrated approach to patient care management. These models connect reimbursement to care quality, cost-effectiveness, and patient outcomes. Success with value-based care models requires strong partnerships between payers and providers. Digital health initiatives should be a key component of a joint payer-provider strategy to optimally engage patients with their care, leading to better outcomes for patients and positive financials for health plans and providers.
The Growing Shift Toward Payer-Provider Alignment
Historically, payers and providers have been at odds with each other and had misaligned financial goals. From a provider’s perspective, financial benefit has been tied to larger volumes of patients and more services ordered. On the payer side, profit has depended on higher premiums and lower reimbursements.
As a result, patients have received suboptimal care, with higher out-of-pocket payments, unnecessary care, and poorer outcomes. With the rise of value-based care and aligned incentives, collaboration between payers and providers is becoming the norm. When patients can access quality care in a timely and efficient manner, it benefits health plans and providers alike and leads to better outcomes for patients.