Payers and Providers: Developing At-Risk Programs

Quick Overview

As providers enter at-risk payment models, they are learning to benefit from closer working relationships with payers.

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Pubcode: INTEL0316
Price: $499

Payers and Providers: Developing At-Risk Programs

Through risk-sharing agreements such as ACOs, leading organizations are acquiring hands-on exposure to strategies and tactics to address delivering value-based care, even as most care is still delivered under fee-for-service reimbursements. They are seeing that a new era of accountability is emerging, and providers know that they and their payer partners need to come to an understanding about the performance metrics for value-based care. With accountability comes increased dependence on data, to be recorded, shared, assembled, and analyzed. Providers should expect to dedicate resources to meeting stricter data integrity requirements, and to administering what are becoming closer working relationships with payers.

In this latest report, peer leaders examine ways to benefit from closer working relationships with payers. You’ll find crucial data discussing how experiences now should help develop expertise that will be vital when value-based payments are the norm. You’ll learn:

  • The leading areas of improvement most sought after in upcoming commercial payer negotiations.
  • What commercial reimbursements processes need to be improved to better work within provider organizations. 
  • How UC Davis Health System partnered with Anthem Blue Cross to enhance care coordination through data and analytics.
  • How data and metrics are factoring into payer negotiations. 
  • How OSF Healthcare System is improving aspects of quality, safety, patient satisfaction, and cost through ACO relationships.

This month’s report includes:

  • Two enlightening case studies from: US Davis Health System and OSF Healthcare System
  • Insight about payer-provider relationships from advisors drawn from our HealthLeaders Media Council
  • Recommendations from the HealthLeaders Media research team
  • A meeting guide to share with your organization

You can use this report to: 

  • Track the latest trends in payer provider strategies
  • Gauge your organization's performance and progress compared to peer organizations
  • Gather insights and advice from industry experts, peer leaders, and the experiences of case study organizations
  • Access discussion questions that can aid your organization in forming strategies for payer provider relationships