Dean Farley, vice president of Provider Reimbursement, and David Chennisi, vice president of System Integration, both of Optum Payer Consulting, recently presented a webinar on why IT is a critical enabler to payer and provider convergence.
Health care has been reshaped over the last few years due to the slow economic recovery, the Affordable Care Act, provider consolidation, demographic changes and new technologies. There is more emphasis on prevention and population health, sustained focus on administrative and medical expense, and more effective provider relations and network management. And most importantly, payers and providers are converging and sharing risk in health care.
As they converge, IT is becoming a critical enabler:
- Data-driven decisions: Data is at the foundation of what plans and providers need to make well-informed decisions.
In addition to a robust data warehouse, plans and providers need to have the ability to customize for market conditions and have the appropriate methodology and analytics to be able to access the data. As risk shifts to the provider, data needs to be in the provider’s hands at the time of care.
- IT maturity of payers and providers: IT structures need to be aligned between payers and providers.
Payers are well equipped with the money and technology to deal with the changes in health care. Many providers are not equipped. The most successful providers will take advantage of the infrastructure created by benefit plans to use clinical information and new care models effectively.
- Innovation driven by technology: New technologies need to be focused on cost savings that reduce the shared savings risk.
Value-based contracting blurs the distinction between benefit plans and provider organizations. As new financial arrangements are constructed between payers and providers, both organizations need to work together on investing into those technologies that provide the greatest ROI and shared savings.
Winners at the reshaped health care will enable technology that increases quality while decreasing costs.
About Optum
Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With approximately 80,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE:UNH).
About DistilNFO
Optum commissioned DistilNFO, a publication house that operates seven industry vertical focused publications that reaches health care, retail and IT executives worldwide, to promote the webinar series. For more information on DistilNFO, please visit https://www.distilnfo.com.