Healthcare is one of the most important parts of living a comfortable life and is an essential part of society. However, it is incredibly complex and propped up by a vast network of doctors, medical professionals, and some of the most brilliant and professional minds in the world. A key component of this system is the relationship between payers and providers. This relationship is integral to the entire experience and, more often than not, can be life-saving for the patients in question.
Use a dedicated software program
Like many systemic problems that industries face, some clever entrepreneurs manage to find incredible solutions using computing and software. Many software programs are aimed at making payer-provider partnerships stronger and more beneficial to both parties and to patients. Using these apps, it’s easier than ever to share information and metrics with payers, giving them a closer look at the procedures and treatments that are occurring and how effective they are. While a lot of patients aren’t able to be treated due to slow communication between parties, this software solution changes that, allowing for rapid communication and decision-making.
Use a better payment agreement.
Most payment agreements in these partnerships are based on a fee-for-service model, which means that doctors will be reimbursed for the service they’re providing at a flat fee. However, value-based payment agreements focus more on the patient and the outcome of their treatment. As a result, the financial goal is tied to the health of the patient, and both the paying company and the healthcare provider will be encouraged and incentivized to get the best possible solution. While it’s not always easy to motivate companies to pursue the best option for patients while spending more money, that is possible under this arrangement.
Better data sharing
As mentioned previously, one of the biggest weaknesses of payer-provider relationships is slow communication. Each procedure needs to be vetted and confirmed by a company, whether it’s an insurance agency or some other kind of entity, and this results in slower confirmation. While doctors are waiting for the procedure to be confirmed by the relevant companies, the patient could enter a critical condition in which rapid intervention is necessary. Sharing data in a better and more efficient way is crucial if you want to eliminate this risk. Some hospitals manage this by hiring care managers who are their representatives in these matters, ensuring the data goes directly to the decision-makers in the insurance company.
Share metrics.
In order to hold and sustain a good business relationship, it’s integral to meet once in a while and figure out the state of affairs together. While many insurance companies and healthcare facilities are as far apart as possible in terms of day-to-day management, sharing checkpoints and holding seminars, talks, and meetings together can be beneficial. In these meetings, using shared metrics from both parties, you’ll be able to figure out the treatments that are the most effective, both cost-wise and in terms of results. With this information, you’ll be able to provide better care than ever.
Shared risk systems
Another unique system that some hospitals and payment providers have agreed to is a shared risk system. This system is unique because it highly incentivizes the health of the patient, even making the entire payment plan rely on the outcome. If a patient isn’t able to fully recover, or there are unforeseen risks or complications, either the hospital or the payer could be held financially responsible, which makes both of them less likely to pursue treatment if there’s risk involved. However, in a shared risk system, both parties are financially vulnerable, spreading the burden and ensuring that the health of the patient is the most important consideration.
Conclusion
Healthcare is considered a basic human right, and the equipment available at hospitals, as well as treatment plans, have been advanced far enough for this right to apply to everyone. However, these advancements have made healthcare more expensive, which means that the relationship between payers and healthcare providers is an essential part of the system. This system allows patients to get their treatment on time, often getting life-saving intervention, while still being able to figure out a payment plan or having their bills paid for to get whatever they need.
