Enhancing Payer-Provider Collaboration to Advance Value-Based Care Implementation

Value-based care (VBC) stands as a transformative model in healthcare, shifting reimbursement from volume to patient outcomes, thus incentivizing providers to enhance care quality. However, its effective implementation requires overcoming significant challenges, primarily stemming from fragmented data systems and misaligned incentives between payers and providers. Amanda Banister, Senior Manager of Provider Performance and Tech Utilization at Veradigm, highlights the critical role of payers in steering the next phase of VBC by fostering effective collaboration with providers. The existing disconnect between payers and providers, exacerbated by siloed, delayed, and context-lacking data, undermines the holistic understanding of patient health necessary for VBC success. Providers face administrative burdens and workflow disruptions due to clunky portals and manual processes, which hamper their ability to manage risk and close care gaps efficiently. Banister emphasizes that a balanced partnership, grounded in transparency and clear communication, is essential to address these issues, facilitating shared accountability for patient outcomes. Electronic Health Records (EHRs) emerge as a pivotal technology to bridge data and communication gaps, with evolving native platforms enabling real-time actionable insights for both payers and providers. These systems support timely interventions such as care gap alerts, which are critical during patient visits for managing chronic conditions and preventive care activities. Banister advises payers to set attainable, measurable goals for providers and to deliver real-time, relevant data rather than overwhelming spreadsheets. Moreover, incentives tied to shared savings or bonuses should be transparent to motivate provider engagement without micromanagement. To foster trust and reduce friction, the insurance industry must prioritize interoperability and ecosystem thinking, creating pathways that support provider efforts in delivering value-based care. Such strategic alignment between payers and providers could accelerate VBC adoption, improve patient outcomes, reduce unnecessary hospitalizations, and control healthcare costs by leveraging shared, actionable data.