Explore how payer-provider collaboration in value-based care is revolutionizing healthcare, leading to improved outcomes and cost efficiency.

1. Unlocking
Value-based Care
through Enhanced
Payer-Provider
Collaboration
Anand Jha
Corporate Vice President,
Digital Transformation, Healthcare

2. Rising care costs and a lack of connection
between health spending and health
outcomes have seen value-based care models
emerge as healthcare’s great new frontier.
The journey toward this transformative future
has seen notable progress. In a recent study,
a compelling 80 percent of physicians expressed
interest in participating in value-based care
arrangements.1
Regulatory developments are
also fueling this change. In the US, the Centers
for Medicare & Medicaid Services or CMS aims
for 100 percent of Medicare beneficiaries to be
in accountable care relationships by 2030,
setting the scene for a decade of innovation.2
Significant financial backing is aligning with
this vision. Investment in value-based care in
the US soared to USD 10.7 Billion in the
12 months ending March 2023 – a remarkable
39 percent increase from the previous year’s
USD 7.7 Billion.3
Despite this surge in interest, providers face
many hurdles when adopting value-based care
models. In a system still geared more toward
fee-for-service, many do not feel equipped to
take on risk-based payment models. Barriers
such as resource limitations and new reporting
requirements persist, while payers demand
evidence of the value provided before
reimbursement.
These challenges, though formidable, are not
insurmountable. A new era of payer-provider
collaboration is the key to overcoming them.
Through enhanced data exchange, collaborative
governance and shared expertise, payers and
providers can jointly deliver better health
outcomes at reduced costs, creating
next-generation patient experiences. This
article delves into how this transformative
landscape can emerge.
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1
https://www.bain.com/insights/what-will-it-take-for-physicians-adopt-value-based-care-snap-chart/
2
https://www.cms.gov/blog/cms-innovation-centers-strategy-support-high-quality-primary-care
3
https://www.healthcare.digital/single-post/value-based-care-what-exactly-is-it-and-how-much-money-is-being-invested-into-vbc

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Healthcare, a highly fragmented and rapidly evolving sector, lags in meaningful payer-provider collaboration due to
misaligned objectives. With a growing emphasis on consumer centricity, payers and providers are aligning their
services to better cater to the unique needs of patients.
Greater transparency is paramount to achieving these goals. However, industry dynamics must first shift to favor this
re-thinking of health systems worldwide. For payers and providers, this means working together to define the value
in value-based care, aligning what matters most to patients and populations.
This can be achieved through collaborative advisory councils, among other things, enabling companies to assess
capabilities and implement governance based on agreed financial and outcomes design. The fragmented nature of
providers – in terms of size and competency – underscores the need for payer collaboration to develop the right
contracting models and build appropriate care strategies. Simultaneously, alignment among executives, operations
and clinical leadership can further set the right agenda for embracing true transparency.
Embracing Radical Transparency
to Break Down Silos

4. Developing a Holistic Patient View
through Data Exchange
Perhaps the most significant impact of greater collaboration is the development of a nuanced understanding of
patients’ needs. Payers and providers can achieve this together through data exchange, creating a unified
360-degree view of patients applicable across multiple process areas.
Already, data contextualization platforms are enabling providers to seamlessly integrate and contextualize healthcare
data, simplifying processes, delivering superior business outcomes and building trust with members and providers.
Data from payers can add further depth to insights gleaned from integrated and holistic healthcare data, unifying
member journeys and better serving those with complex healthcare needs. This openness can augment existing
data and analytics capabilities within healthcare.
Re-defining Patient-centricity
with Next-generation Capabilities
From this collaborative vantage point, the possibilities for value-based care are endless. Payers and providers will be
empowered to build next-generation care and population health management capabilities, ushering in an era of
enhanced self-care and preventive care for better outcomes.
Organizations can harness new technological advancements to re-define patient-centricity. Tapping into rapid
advances in telehealth-related services, for example, can drive enhanced outcomes for payers, providers and patients
alike. A recent collaboration with a telehealth platform saw one payer partner reduce emergency department visits
by 40.5 percent.4
Meanwhile, next-generation wearables and remote monitoring tech can further enhance
technology’s role as a health facilitator, creating new opportunities for prevention and self-care.
Collaboration also unlocks the full transformative power of Generative AI (Gen AI), addressing payer organizations’
key challenges, such as reducing administrative costs and enhancing personalized experiences for members.
Merging payer and provider datasets could prove a game changer in driving personalized care at a community level,
with Gen AI adoption (in healthcare) expected to outpace other industries – projected to register a compounded
annual growth rate of 85 percent through 2027.5
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4
https://www.fiercehealthcare.com/digital-health/long-term-plans-hybrid-care-begin-take-shape-health-systems-and-digital-platforms
5
https://www.bcg.com/publications/2023/generative-ai-in-medtech
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Partnering to Improve
Patient Care
As the health industry moves toward value-based care, providers and
payers must be ready to address key challenges that hinder progress.
Collaboration is integral to ensuring patient-centricity thrives. This
collaborative sentiment goes far beyond the payer-provider relationship,
with leading service providers stepping forward to offer comprehensive
clinical and care expertise, unified experiences and access to artificial
intelligence and analytical capabilities. In doing so, a landscape defined
by high touch and high-tech care is swiftly emerging, driving better
health outcomes across all stakeholders.

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