Health systems: Do you see payers as partners or adversaries?

“It’s not the fact that we did that, it’s how we did it.”

That’s what Jeff James, chief executive officer for Wilmington Health says is the headline from his group’s decision to team with Blue Cross/Blue Shield of North Carolina to create that state’s first commercial accountable care organization (ACO).

So how did Wilmington Health create the ACO? James explained the health system adjusted the way it viewed its relationship with BCSBNC.

“We treat Blue Cross Blue Shield as an absolute partner, not as an adversary,” said James.

“We try to take into account their concerns, their worries, their needs and we develop situations where we can both thrive.”

The Optum white paper A Model for Value-Based Provider/Payer Partnerships shows the rarity of relationships like this one.

5in5

Certainly ACOs are not the only fee-for-value model. But aligning the financial incentives of payers and providers may offer opportunities to drive down medical costs, increase commercial market share, and reduce redundancies.

It’s a change that’s not always easy. A 2013 report in HealthLeaders Media pointed out health systems are accustomed to meeting payers at the negotiating table to hammer out contracts. It’s a relationship that’s traditionally been adversarial.

But the article went on to explain payers can bring value to partnerships – providing money for investments, data, predictive modeling tools and support for wellness programs.

Take five minutes to watch a #5in5 interview with James. He addresses how the Wilmington/BCBSNC ACO has affected admission and readmission rates, ER visits, and costs. He also talks about the tools the ACO used and shares his top three pieces of advice for an organization implementing an ACO.

About the Author:

LH_low-resLeslie Cozatt currently serves as Director of Marketing, Optum Provider – Thought Leadership and Content Strategy.

She directs the development of content that spotlights the role of data analytics in healthcare – specifically the transition to value-based care, risk management and population health management. She brings to her role more than 20 years of experience developing B2B and B2C integrated marketing campaigns for companies including ThreeWire, Eliance and 3M. Leslie attended the University of Minnesota and graduated from Wellington College with a BS in International Business & Communication.

2 thoughts on “Health systems: Do you see payers as partners or adversaries?

  1. Are all Blue Cross Blue Shield Licensees the same? I think it would be important to differentiate between the various licensees – since they are NOT all the same.

    • Thanks for the question, Steve. No, our understanding is that not all Blue Cross Blue Shield licensees are the same. Building off your point, every provider/payer relationship is unique in its own way. The Wilmington/BCBSNC ACO is one example of a mutually beneficial success story.

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