Population Health Experts Help Drive Payer-Provider Convergence

December 20, 2017
Shelley Riser, Vice President, Consulting Services and Clinical Innovation


Hispanic doctor talking with patient

Chilmark Research defines payer-provider convergence as “initiatives and technologies that promote more efficient exchange of information between payers and providers as the roles between these stakeholders continue to blur.”
They identify convergence as a key strategic driver that impacts everyone in the pursuit of streamlined health services for patients.

I could not agree more.

For more than 25 years, I have worked to make a difference at every level of care delivery, to bring together system-wide stakeholders to improve cost efficiencies and patient outcomes. Driving alignment among healthcare professionals has never been more critical than it is now as payers and providers increasingly share the risk and reward for delivering cost-controlled, high-quality care that demonstrably improves the health of the people they serve. 

Health plans and care delivery systems need shared, innovative tools and programs to successfully converge around patient-centered care. 

Technology alone is not enough.

There is an understandable and necessary focus on data-driven technologies to lead the charge on increasing collaboration. But in addition to technology, we need new perspectives and processes to help turn insights into actions that matter. Providers need more ways to translate data-driven findings into straightforward, concise information that helps frontline clinicians take the best possible action, within the required timeframe, for each patient. 

This is where my team of population health experts comes in.

On behalf of our health plan clients, we work with value-based provider partners to help them understand what is working well and where there is room for improvement within the framework of population health management and value-based contract performance. We meet regularly with physician leadership and partners and dive into the data to develop reasonable plans of action to address variations across patients, providers and facilities. 

Putting analytics into patient-level action and developing effective engagement strategies to positively influence the health of individuals and populations is challenging. Leading health plans provide population health experts to lighten the load for providers and help them achieve success within their value-based arrangements.

The following three-pronged approach is helping to forge deeper relationships between one health plan client and its value-based provider partners: 

  • Freely sharing data and analytics. When physician leadership teams and clinicians can independently verify the source of insights, they become better equipped to manage risk and populations responsibly.
  • Improving workflows. Efficiently shifting the delivery of care from an episodic to a holistic approach requires processes and technology that support, facilitate and ease the way. 
  • Layering expert population health guidance on top of proven technologies. By providing clinical teams with succinct information about members in need, at risk and with rising risk, it becomes manageable for them to create realistic action plans with measurable outcomes. 

Download our case study for an in-depth look at how this approach is helping to drive convergence and improve the performance of value-based contracts for one health plan client and their provider partners.


Related Blogs