Payers and providers have a complex relationship. Stereotypes suggest payers want to cut expenses, while providers want quality care (regardless of cost). Conventional wisdom says these parties have treated each other with suspicion in the past.

But the U.S. healthcare industry is in the midst of evolving to new outcomes-based payment models, and as a result the payer-provider relationship is evolving. As providers become more responsible for cost, payers are willing to offer information and expertise. Provider insights about practicing medicine can enrich payer data.

Both sides share the goals to improve quality and reduce expense. There is a more collaborative approach among payers and providers in the U.S. healthcare industry today than ever before. I believe that trend will continue.

How Allscripts helps strengthen these collaborations

Allscripts can make these collaborations even stronger. Our solutions connect more patients with more caregivers than any other healthcare IT company. The Allscripts community includes 13,000 post-acute facilities and 1 in 4 U.S. hospitals. We have 180,000 physician users and 50,000 physicians using our patient portal.

In order for the new healthcare paradigm to be successful, this collaboration must extend beyond the payer and provider to the patient as well, primarily since the patient is starting to play a very active role in managing health outcomes and costs

With such a robust community, we can help foster this innovation and connection, and not just among providers and payers. We are bringing together parties that are traditionally on the fringes of the payer-provider relationship, such as pharmaceutical companies, research organizations and pharmacy benefit managers.

Ultimately, strengthening these connections improves quality of care and cuts costs for everyone along the continuum. We sell software and services that:

    • Use big data to speed outcomes-based research. As EHRs mature, more organizations realize the value of the data that a connected community can capture. Our solutions aggregate and “anonymize” data to give insights to both providers and payers. Using the data for analytics, research, clinical trail management and other purposes helps lower costs overall.
    • Help with day-to-day transactions to improve clinical outcomes. From prior authorization to clinical decision support, these tools help clinicians. For example, patient education and adherence programs can help with compliance and improve results.
    • Automate manual processes.  Technology can reduce burden and expense by creating a secure connection between providers and payers for chart audits.  Accelerating the transfer of chart information can reduce administrative burden and speed payment.
    • Improve claims management systems to make billing more efficient. With Payerpath, payers and providers appreciate more accurate, timely claims.
    • Enabling patients to be more engaged in their health care. Allscripts integrated set of patient engagement solutions enable improved patient education, patient adherence, office visit payments.

By connecting all the players in the value chain, we can bring more innovation to the market. We continue to think BIG in this space. Because the stronger these relationships are, the more opportunities we have to improve health care.

Do you see more collaborative payer-provider relationships in our future? Please share your thoughts in the comments below.

Tags: , , , , , ,

About the author

Faisal Mushtaq is President of Allscripts Payer Life Sciences business. This business focuses on generating immediate value for providers and patients by leveraging Allscripts data and clinical, adherence and education messaging infrastructure to enable improved clinical outcomes at a lower cost. Faisal leads a team of cross-functional professionals skilled in field sales, product management, and client support and implementation services. He also oversees the PayerPath business. Faisal has been in the healthcare IT industry since 2000 and has extensive entrepreneurial business experience. He has led teams of all sizes, spanning many organizational areas including Portfolio Strategy, Sales, Business Development, Technology, Operations and Software Development. Before Allscripts, Faisal served in several leadership roles at Misys, which was acquired by Allscripts in 2008. Following the acquisition, Faisal served in various executive leadership roles in the Solutions Development organization of Allscripts, including the leader of Solutions Management for the ambulatory market and the leader of Portfolio Management. Faisal is a member of the Board of Directors at the Council for Entrepreneurial Development, an organization that helps entrepreneurs grow their business by connecting them to the network, knowledge and capital needed to start their company. Faisal earned a Bachelor of Science degree in Computer Science and Computer Engineering from the University of Wisconsin-Madison. He has also completed Advanced Management Program at Harvard Business School.

2 COMMENTS on Why payers and providers are collaborating more than ever

avatar

Abbas says:

06/20/2014 at 1:32 am

With the ‘Internet of Things’ picking up fast, data from the devices/sensors can be leveraged too for analytics. Is it being considered in any form at Allscripts?

Faisal Mushtaq says:

06/23/2014 at 9:34 am

Hi, Abbas –

You’re right about the growing amount of healthcare data that comes from devices and sensors. People are tracking their fitness and monitoring chronic conditions with all kinds of wireless devices.

One way that Allscripts is helping connect this data to the electronic health record (EHR) is through one of our newest solutions, FollowMyHealth® Achieve. You can read more about that in a recent blog post: http://blog.allscripts.com/2014/02/25/followmyhealth-achieve-the-missing-link-in-patient-engagement/

Thanks for your comment,
Faisal

SHARE YOUR COMMENTS:

Your email address will not be published. Required fields are marked *


*