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White Paper - Increasing Importance of Payer-Provider Collaboration

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Population Care ™ everal important insights were gleaned from a recent survey administered by analytics and population health management firm SPH Analytics. The survey, conducted to gauge current and future collaboration approaches among payers and providers, sheds light on a number of key trends. More than 94 percent of both health plans and healthcare providers believe collaboration between the two healthcare stakeholders is now a key factor in the success of healthcare organizations. And more than 72 percent of payers and providers already have closer collaboration initiatives in motion. This indicates that, first and foremost, the healthcare industry is moving past some of the general distrust and lack of communication between payer and provider organizations. As recently as 2017, reports of more adversarial relations trumped reports of collaboration – and "technology" and "inaccurate data exchanged" were cited as chief catalysts for the mistrust. Since then, both stakeholders have become more open to collaboration in their quest to lower costs, boost outcomes, and optimize value-based care reimbursement. But although intent to more closely collaborate is expressed by both healthcare stakeholders, the actual execution is still a work in progress. Nearly 80 percent of payers report sending at least some post-adjudicated claims data to providers, but more than 20 percent send none at all. In turn, 20 percent of payers report receiving no real-time clinical data from providers. The Survey Recently, SPH polled more than 100 directors and managers representing 86 healthcare organizations: about two- thirds represented were health plans, one-third were providers, and the remainder identified as "payviders" (both a health plan and a provider). Survey respondents were asked about their opinions, prior experiences, and future intentions relating to payer-provider collaboration, as well as the opportunities and challenges they anticipate. Key Findings 94 % of respondents rate payer-provider collaboration as "very important" or "important" to their organization -- and not a single respondent answered that collaboration was "not important" 72 % of payers and providers have already taken steps to improve their collaboration with each other. 80 % of payers report receiving at least "some" real- time clinical data from providers; 20% report receiving none at all. 47 % of payers do not yet have population health technology solutions that can be used by both payers and providers to collaborate on quality and care management, despite the fact that 95% of health plans reported having quality incentive programs in place with providers. S 2 The Increasing Importance of Payer-Provider Collaboration Findings of a recent study of healthcare providers and health plans

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