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    Successful payer-provider collaborations: 4 characteristics


    Physicians want to do what they went into medicine to do: Take care of patients through building and fostering strong relationships with them. In the fee-for-service world, however, many independent physicians believe that calling cannot be realized. That’s because in order to stay in business, they need to see as many patients as they can during the day—and that translates into seeing each patient for only about 10 or 15 minutes, says Jeff Butler, chairman and chief executive officer of Arlington, Virginia-based Privia Health, a national medical group. Value-based reimbursement, he says, can change that.

    ButlerButler“The opportunity for these providers is to come alongside and be the strategic partners of health plans … and really get aligned on managing a population and getting rewarded, not for doing more stuff, not for seeing more patients, but getting rewarded for keeping people healthy and keeping them out of the acute care setting,” says Butler.

    While value-based reimbursement presents opportunities for payers and providers, succeeding in such a reimbursement model can be challenging. Here are four things to strive for that could increase the likelihood of success in a value-based reimbursement model.

    1. Stronger partnerships

    To take advantage of value-based care payment models, such as accountable care organizations, independent physicians must align with other providers. That alignment requires adapting to common technology, common platforms, common work flow, and common systems, says Butler. “They don’t have to be geographically located next to each other. But they need to be on a common platform that allows them to get the efficiencies and [economies] of scale, and to benefit from the technology and the people and the expertise that are needed in order to be able to take on risk.”

    For larger healthcare systems and managed care organizations that are onboarding new physicians, that means a critical aspect of alignment is providing physicians with the resources necessary to adopt and adjust to the broader organization’s technology platforms.

    When onboarding new practices, Privia Health, for example, introduces physicians to population health and risk management systems that enable them to focus on providing patient care, says Butler. After about four to five months using these systems, physicians can spend an hour with patients who have many complex co-morbidities—instead of the typical 10 or 15 minutes they could spend in the fee-for-service model, says Butler. It makes sense to invest time in these patients, because it could prevent a costly ER visit later, he says.

    Conversely, if patients need something minor addressed, such as a prescription refill, they can see a nurse or communicate with the practice via secure e-mail—instead of having to come in and take up an appointment slot with the physician, says Butler.

    Next: The second characteristic


    Aine Cryts
    Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, ...


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