More insurers, providers likely to merge into ‘payviders’

The boundaries between payer and provider will continue to blur in 2022. Fifty-two percent of hospital executives say they plan to enter into commercial employerbased risk contracts, 49% into Medicare payment models and 36% into Medicaid programs next year, according to a survey from the Healthcare Financial Management Association. Many health systems plan to partner with payers to help them manage the transition from fee-for-service, with at least 30% saying they will collaborate with insurers to build new data integrity, reporting and technology systems, the survey found.

Insurers are budgeting for these new partnerships and expect technology spending to rise nearly 14% next year, according to the Deloitte Financial Services 2022 Insurance Insights report.

By partnering with providers, payers are looking to better control member costs and outcomes. Clinicians can also play an important role in boosting insurers’ Medicare revenue because documenting patients’ health conditions helps determine how much the federal government pays Medicare Advantage carriers. Regulators, meanwhile, have been and will continue to be sensitive to payers misrepresenting patient conditions through upcoding and unverified outside claims. At the same time, insurers are increasingly investing in their provider units. UnitedHealth Group expanded its clinical network to 60,000 providers by the end of 2021, half of whom are primary-care physicians. The company also counts 20,000 advanced practice nurses as part of its workforce. CVS Health hired a record number of employees during its third quarter, including nearly 20,000 pharmacists, pharmacy technicians and nurses. And once Humana’s acquisition of Kindred at Home is complete, half of its workforce will be clinicians.