Building Effective Payer-Provider Partnerships: K2 Collaborative Summit Panel - Cover

Building Effective Payer-Provider Partnerships: K2 Collaborative Summit Panel

Building trust and collaboration between payers and providers is crucial for managing healthcare costs and providing a better patient experience. During the K2 Collaborative Summit, a keynote panel provided key insights on building effective partnerships between payers and providers.

Jim Whitfill, MD, MBA, SVP, and chief transformation officer at HonorHealth, moderated the discussion, while the panelists were Bill Banks, vice president of managed care and revenue cycle at St. Elizabeth Healthcare, and Chris Walker, associate vice president of interoperability at Humana.

Highlights from the discussion follow below.

Moving Beyond the Stereotypes

Banks framed the discussion well when he declared, “There are no bad guys. That is what I tell people every day.” With this view in mind, the panelists spent time addressing what each side can do and sometimes is already doing to become better partners.

Whitfill shared that physicians often feel that payers are just out to get them. Banks took this sentiment head on as someone whose career started on the payer side but is now on provider side. He countered, “That is just not true. The payers understand very well that they depend on a healthy provider community. . . . But you have to understand that payers have a specific job; they’ve been hired by employers to watch their money and their spending carefully.”

Having this in mind, Banks expressed that he and his team approach payer relationships in the spirit of assuming good intent. They trust that payers want them to succeed but that payers want them to do that more efficiently. Banks then advocated for a competitive payer market: “By the same token, I try to preach inside the hospital that we need a vibrant payer community; I don’t want any one payer to have 100% of the market. That’s not good for anybody.”

Focus on Solutions

Walker challenged the opinion in payer C-suites that nothing really changes. Influenced by his product management background, he proposed that instead, we focus on solving the friction points providers experience with payers. He said, “Forums like this are great to talk about the problem and matching solutions to the problems.”

One of these problems is finding common terms around some of the core problems they face. Payers and providers sometimes use the same words, but they can mean different things, making any conversation unproductive. So Walker had his team at Humana create a framework with clear taxonomy. He said, “We found that to be wildly productive in terms of really bridging the gap of how we talk about things in simple terms. I'm super passionate about it because the number of conversations that I've been in where you spend 50% of the time talking past one another is unbelievable.”

The Trust Factor

So how do you build the trust which is key for so many collaborations? Banks talked about the importance of asking “What are you trying to get out of this?” when he sits down with any payer to talk about anything from IT infrastructure to negotiating contracts. He found that to be a better way to begin the conversation and that it would be much more likely to end up getting providers some of what they want too.

Consistency can also help build trust. Walker talked about how Humana has tried to lean into solving problems for providers over the years. He said, “For Humana, this is not a flash in the pan; this has been a multiyear, long-haul investment. That's not stopping—it's growing. Part of that is also a signal that produces some element of trust. But just think about all the Points of Light and all the different topics from yesterday. There are so many different problem statements to solve for. Yet, duration leads to some durability as it relates to trust. Leaning in creates a signal that is really important to say we're committed to this.”

Banks finished the topic by saying, “We've got different business agendas sometimes. So in the spirit of working together, sometimes I'll do something that's expensive for me. I'll call you later when it's contract negotiation time. But that does help the overall relationship.”

Learn More

The panelists shared these and many other insights on the movement toward value-based care and the challenge of interoperability.

This was just one of the discussions that happened during the KLAS K2 Collaborative Summit. For more information or to join the K2 Collaborative, please visit the K2 Collaborative page.