Shared perspectives:
WHY HEALTH PLANS AND PROVIDERS ARE ALIGNING TO ACHIEVE SUSTAINABLE GROWTH
CONTRIBUTING AUTHORS:
Jay P. Hazelrigs, ASA, MAAA, Vice President, Optum Advisory Services
Erik Johnson, Vice President,
Value- based Care, Optum Advisory Services
Braxton Millar, Senior Director, Optum Advisory Services
Increasingly, health plans and providers are considering a valuebased model to lower care costs and achieve the right growth for their organizations. Also increasingly, they realize they can’t realize their objectives alone: It takes strategic collaboration to make significant and sustainable progress.
Think of collaboration as a way to create the most complete view of value- based opportunities. Health plans are limited in their ability to infl uence quality, cost- effective care at the patient level. Put simply, it’s hard for them to see the individual trees. Providers, on the other hand, can be limited in their line of sight to the complexities of effectively managing risk — or their ability to see the forest.
IMAGINE A SCENARIO WHERE PROVIDERS, HEALTH PLANS AND PATIENTS ARE MORE ALIGNED.
Working together, each can gain the perspectives they need to yield value for all. This is what success through collaboration can look like.
Three ways to jumpstart collaboration.
1. IDENTIFY MUTUAL GOALS.
Collaboration requires thinking about the patient from the other’s perspective. Health plans consider the clinical and patient view more than ever. Providers evolve their ability to take ownership of lives, rather than episodes of care. Both stakeholders consider how they can work together to develop a more affordable and differentiated experience to employers and patients in a way that fundamentally disrupts incumbents.
2. DEVELOP SHARED DATA SETS FOR VALUE COLLABORATION.
Data sharing and integration enable health plans and providers to identify and validate what each can achieve by working together. A shared data set should include claims and clinical data as well as social determinants of health for specifi c populations. Careful analysis of this data can pinpoint where excessive costs exist for specific populations. And it can provide a basis for collaboration in designing value- based solutions.
3. BUILD A FRAMEWORK TOGETHER FOR VALUE- BASED GROWTH.
Identify the key capabilities needed to enable shared risk and benefits — the overall strategy.
• Collaborate on the data and sharing knowledge to develop value- based objectives.
• Identify the market segment ripest for disruption and key populations.
• Evaluate the actuarial opportunity, pricing/ financial models and market share business case.
• Determine the enabling technology and talent roadmaps.
Once the strategy is defined, build and operationalize the models together, including:
• Designing products aligned to target populations
• Configuring the network, aligning and engaging providers
• Aligning care pathways with financial and quality models
• Building work streams and performance reports to enable transparency and operational excellence
• Developing care coordination and consumer engagement plans
Working together provides the complete perspective
Collaboration provides the opportunity to disrupt a region with a more competitive, patient-friendly experience. New value- based models are emerging. All emphasize the need to go beyond surface relationships to building a deeper mutual commitment that supports shared growth objectives. By working together, each organization can take a leading- edge position to achieve its growth goals.
Learn more about how Optum helps health care leaders like you collaborate for mutual success. Visit optum.com/ partnersinvalue to read the full article.