Care Collaboration for Health Plans & Payers in Value-Based Care

Supporting care coordination and enhancing collaborative relationships is another piece of the puzzle for health plans and payers driving the shift to value-based care. Everyone throughout the continuum of care – from primary care providers to hospitals to post-acute care facilities – need to be able to share data and communicate care plans to support appropriate treatment, timely outreach, and safe care transitions for improved outcomes and reduced spending.

In our fourth blog of this series on how health plans can support the transition to value-based care, we look at the role of care collaboration, challenges to these efforts, and care coordination solutions that can help.

Care Collaboration and New Technology are Top Priority

A 2022 survey of healthcare CFOs found that 41% plan to focus innovation around collaborations and partnerships with 29% of partnerships driven by new technology and capability integrations. Collaboration between care team members, as well as collaboration among payers and providers, is necessary to improve patient outcomes while reducing cost of care. Payers have access to a holistic view of member health information and services rendered, which can be valuable to the care team when it comes to providing the best care and treatment options available.

A focus on more care collaboration in healthcare is also fueled by more recent regulations easing barriers to information exchange. For example, the Code of Federal Regulations Title 42 section provides guidance on data sharing for substance use disorder patient records, and legislation such as the CMS psychiatric collaborative care model (CoCM), which incentivizes collaboration between primary care and behavioral health providers. These regulations are intended to facilitate information exchange across the care continuum for enhanced collaboration among providers while complying with laws around patient confidentiality.

Collaboration Challenges That Disrupt Care

One of the primary obstacles for care collaboration revolves around stakeholders in healthcare agreeing on how to provide effective care. Healthcare providers often struggle with the limitations imposed by payers regarding what services are covered and what they see as appropriate treatment protocols. Meanwhile, health plans and payers are focused on streamlining care and reducing excessive cost and unnecessary or duplicative services — and may not understand how a common procedure or practice supports a value-centered paradigm. These challenges can lead to disruptions in care, problems with care transitions, and redundancies in care delivery.

How Technology Can Support Better Care Coordination

The use of smarter technology networks to facilitate collaboration, dispatch real-time alerts about high-risk members, and deliver critical information to the point of care, can improve coordination, cost savings, and transitions of care — all of which are critical for health plans to support the care continuum. Health plans also need to ensure they are putting enough resources into preventive care and proactive outreach efforts to help close care gaps, reduce adverse events like readmissions, and improve member outcomes and outlook.

Healthcare organizations need to ensure they have the tools and processes in place to support their current and future collaborative processes. Taking stock of current technology capabilities and platforms that support care collaboration is the first step to enhancing coordination throughout the care continuum to overcome these challenges and provide a better experience for members and providers.