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Points of Light 2022
Recognizing Successful Payer/Provider Collaborations

author - Boyd Stewart
Boyd Stewart
author - Lois Krotz
Lois Krotz
May 5, 2022 | Read Time: 4  minutes

Despite their common goal of enabling efficient, effective healthcare, payer and provider organizations often find themselves at odds, struggling to navigate the intersections where disparate processes and systems converge. The goal of KLAS’ new Payer/Provider Initiative is to help reduce this friction by facilitating trust, collaboration, and alignment between payers, providers, and HIT vendors.

As part of the initiative, the annual Points of Light awards celebrate success stories—or “points of light”—from payers, providers, and vendors who have partnered together to reduce costs and inefficiencies and improve the patient experience. 14 such collaborations were awarded a 2022 Points of Light award, and their strategies and outcomes are shared in this report to illustrate the art of the possible. The report’s Executive Overview provides a high-level summary of the types of challenges tackled and the outcomes achieved, while the full report provides an in-depth case study of each collaboration. See page 6 for the full list of winners.

payer provider points of light logo

A note about award methodology: Points of Light awards are given to payers, providers, and IT vendors who demonstrate close collaboration that leads to shared outcomes. KLAS validated submissions via a standard set of questions administered during in-depth interviews with representatives from all relevant stakeholders.

Points of Friction (and the Technology Used to Tackle Them)

There are myriad points of friction that provider and payer organizations could target to reduce administrative waste and improve patient outcomes. The challenges tackled by the 2022 Points of Light award winners fall into six overarching categories, the most common being issues related to prior authorization or value-based care.

types of challenges tackled

Prior authorization: Obtaining prior authorization for medications, imaging, and procedures can be a significant source of administrative inefficiency as well as patient frustration, and it was the most common area of focus among this year’s award winners. The partnerships that focused on streamlining this process leveraged strategies such as artificial intelligence, clinical decision support, and improved interoperability.

Value-based care: Achieving better outcomes and lower costs requires improved data exchange that allows provider and payer organizations to understand their patient/member populations, provide needed care management, and close gaps in care. It also requires both provider and payer organizations to develop new operational and financial knowledge to effectively sustain bundled-payment programs.

The Role of Technology Partners

The variety of technologies that collaborators are using to reduce friction speaks to the complexity of the task at hand and the fact that there are often multiple options for achieving outcomes. KLAS’ hope is that examining these options will help other organizations identify technologies that might be helpful in their own strategies. Which option is best will largely depend on the collaborators’ resources, budgets, relationship, and timeline. The table on the next page outlines the specific challenge each group of collaborators was trying to solve, the action plan created, and the technology implemented to support it.

types of technology partners
payer provider points of light overview of points of light collaborations by type of challenge tackled

Points of Light: Top Outcomes Achieved through Collaboration

The collaborations highlighted in this report have achieved a variety of outcomes, the most common being improved efficiency in the administrative tasks between payer and provider organizations as well as positive financial results.

top reported outcomes
improved efficiency improved financial results improved processes
improved care quality improved patient experience improved provider experience

Key Lessons Learned

Any efforts to improve collaboration and alignment between payer and provider organizations will require active participation from all stakeholders. Organizations looking to implement their own collaborations can benefit from those who have already walked the path. The 14 collaborations examined in this report yielded many best practices, but the four key lessons outlined below emerged as the most common. Additional best practices can be found in the full case studies.

Cultivate an environment of trust

Clearly outline your definition of success

Create the people and governance structures necessary for success

Understand what your technology partner can (and can’t) offer

  • Build trust through frequent, transparent dialogue and structured, intentional collaboration
  • All parties must be committed
  • Let go of past narratives that may exist regarding the payer/provider relationship
  • Create a clear, concise definition of success
  • End goals must be win-win scenarios (i.e., use cases that have value) for all involved parties
  • Start small—decide what phase one will look like and then scale up
  • Don’t be afraid to reevaluate as needed
  • To ensure rapid adoption of technology, create a governing council with provider representation
  • Adjust the organizational structure as needed to carry out new processes successfully
  • Involve key stakeholders early on—it may be critical to have a dedicated team, physician champions, an operational owner, or staff expert liaisons (for provider and payer communication)
  • Choose a technology partner that brings all stakeholders to the table
  • Technology vendor must understand any relevant regulatory requirements (e.g., those for value-based care or revenue cycle
  • EMR vendors may need help understanding the back-and-forth that happens between payers and providers
payer provider points of light recipients of a 2022 points of light award
author - Elizabeth Pew
Elizabeth Pew
author - Madison Moniz
Madison Moniz
author - Robert Ellis
Project Manager
Robert Ellis
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.