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Payer-provider relationships: Pre and post COVID-19 worlds

October 27, 2020

Restructure contractual agreements
Post-COVID, there is a need to restructure agreements in order to ensure the financial burden is reduced, while trying to meet the proper performance benchmarks. Risk sharing models must be restructured and a balance needs to be struck between FFS and VBC models to ensure both payers and providers are able to overcome the financial burdens they’re separately facing. It’s recommended both parties evaluate other shared savings models and ensure agreements are divergent and restructured to include telehealth services, home health and other remote care services.

Both payers and providers are undergoing fundamental restructuring to meet the needs of VBC models in a post-pandemic world. Collaboration has been seen in the industry across the continuum of care and it’s important payers and providers continue to be more vertically integrated to form even tighter partnerships.

To help the healthcare ecosystem succeed in evolving VBC models, productive payer-provider partnerships and proactive collaboration is a must. A successful collaboration is possible when payers and providers create a customized roadmap for themselves that leverages best practices with a robust technology platform to support their growing needs. In addition, a plan that includes cost transparency, structured well defined contracts, identifies high risk patients, implements PHM initiatives and reduces cost utilizers are key stepping stones in reducing overall healthcare costs. Overall, when payers and providers implement a successful VBC model, the patient’s overall wellbeing will be the prime motto.

About the authors: Abhay Singhal, is SVP of Provider and Healthcare Services at CitiusTech. Sheetal Sawardekar is Sr. Healthcare Consultant at CitiusTech.

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