The future of value-based care relies on payer-provider collaboration

Megan Zakrewsky: ©Veradigm

For years, value-based care has remained a central debate in the health care industry amid the ongoing push to improve outcomes while controlling costs. Traditional fee-for-service models have revealed their limitations, such as data fragmentation, misaligned incentives, regulatory complexity, technology gaps, and an overall cultural hesitancy to adopt to a new business practice. These challenges contribute to provider burnout and fatigue, as well as a lack of trust and transparency between payers and for physicians specifically.

At its core, value-based alignment truly asks health care leaders to answer a simple question: how do we reward what matters the most (better patient outcomes) rather than volume of services delivered? Achieving this shift requires not only new payment models, but cultural change, shared accountability, and the willingness to rethink decades of accustomed behaviors.

However, as stakeholders across the health care ecosystem look to align incentives with patient health, payers and physicians have an opportunity and responsibility to collaborate to move the industry forward and solve their unique pain points along the way. Together, payers can work with physicians to shape incentives, guide behavior and ensure the right data and tools are in place to support this transformation. Both sides must recognize that success is not measured only by financial performance, but also by improvements in equity, patient trust, and outcomes. Here are a few considerations to fuel success.

Build a common language and understanding

Not all physicians are equally familiar with value-based care models, especially independent physicians located in rural and underserved communities. However, payers can help facilitate collaboration among physicians in their network, enabling them to share best practices and learn from others’ experiences. Additionally, payers can support training and education opportunities for physicians, helping networks better understand value-based care models, care coordination techniques, quality improvement strategies, and other concepts critical to success.

On the other end, physicians can educate payers on the realities of delivering care that might historically be siloed from their point of view, especially as it relates to managing high-risk populations or resource-limited environments. To achieve the common goal of value-based care, education must be a two-way street.

Share data to create a single source of truth

Value-based care depends on access to timely, accurate, and actionable data. Yet, many payer and physician relationships are hindered by data silos, interoperability issues, and mistrust over how data is used. By sharing relevant patient data responsibly with physicians, payers can help identify trends, care gaps, and opportunities to improve patient engagement and drive better health outcomes. More specifically, payers can help surface gaps that might not otherwise be apparent, ranging from persistent conditions a patient has already been seen for, to conditions that payers suspect a patient may have based on trends in their data. Using these insights, physicians can engage patients in preventative screenings or social-determinant of health-related programs, such as transportation or nutrition support. This data is powerful when used in real-time at the point of care.

Payers can also empower physicians to seek performance analytics to help them understand their performance compared to national standards and benchmarks. This type of timely performance feedback can give physicians actionable insights for their improvement, impacting their HEDIS scores and Star Ratings, while helping to build trust in value-based payer-physician partnerships.

Equally important is ensuring that the data shared is meaningful — not just massive amounts of historical clinical insights, but rich information that providers can quickly understand and use in their workflows. Without data usability, information overload risks compounding provider frustration rather than alleviating it.

Predictive technology’s power to align payers and physicians for smarter collaboration

The shift towards value-based care calls for tools that leverage predictive analytics and AI to dig deep into data. Advanced analytics enable physicians to leverage actionable insights from patient data to help improve care and outcomes. More specifically with predictive analytics, physicians can more easily identify high-risk patients, enabling earlier care interventions and personalized care plans. When applied to past scheduling data, predictive technology can help forecast patient demand and optimize appointment flows for physicians, resulting in better operational efficiency.

On the payer side, these predictive models can support targeted interventions like outreach for preventive screenings to close care gaps, reduce hospital readmissions, and improve population health while controlling costs. Real-time analytics solutions can monitor key performance indicators related to value-based contracts, including readmission rates and emergency utilization.

Overall, predictive technology can empower physicians to make informed decisions and help payers evaluate the effectiveness of their programs. With the right value-based care-focused solutions that promote easy use and intuitive workflows, payers and physicians can leverage a data-driven approach to align objectives, supporting a more collaborative effort to enhance patient care while managing health care costs.

Value-based care as a shared responsibility

Both stakeholders bring unique strengths and perspectives to the table. The shift to value-based care is not a payer initiative or a physician initiative, but rather a health care initiative. Enhanced collaboration across the health care ecosystem means a multitude of benefits: improving the management of chronic conditions, reducing the total cost of care, lowering administrative burden for physicians, supporting better quality scores for payers, and building trust. When aligned around shared goals, payers and physicians can educate each other, exchange actionable data, and leverage the right technology to collectively improve outcomes, reduce costs, and create a more sustainable health care system.

Megan Zakrewsky is the Vice President of Product for Clinical Data Exchange Payer Solutions at Veradigm. In this role, she is responsible for a portfolio of solutions facilitating data exchange between providers and payers, primarily supporting payer risk adjustment and quality initiatives. Prior to Veradigm, she spent time working on provider-provider and provider-patient health information exchange solutions.