Payer and Provider Collaborations - Why Now?

 

Under pressure from competitive threats and government mandates, many providers and insurers have come to the realization that working together may be the only way forward in a healthcare industry. From products and networks to risk arrangements and financial models, several issues must be thoroughly evaluated as part of a payer strategy. Kaufman Hall assists both providers and payers in creating differentiated strategies that improve care and reduce costs.

Understanding the need for payer and provider collaboration

What's Contributing to the Burning Need for Vertical Integration?

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Large integrated competitors are increasingly shrinking the available market

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Consumer expectations of a convenient, seamless experience

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Pressure to control healthcare costs from employers and consumers is mounting

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Intensifying scrutiny from regulators

Trusted in Payer Provider Partnerships

Working on A Broad Array of Managed Care Strategies with Payers and Providers

 

"The health plan isn’t getting into the hospital business, and the health system isn’t getting into the insurance business…instead the two organizations are working together to align the entire strategy around the consumer."

 

— President and CEO, Large Payer Organization

We help your organization look beyond transactions between hospitals and health systems to partnerships between health plans and provider organizations. Our recent payer-provider partnership highlights include:

  • Successful launch of a joint venture health plan between a payer and provider

  • Establishment of a health plan’s provider partnership program to prepare providers to take on financial risk for health plan lives and support the dual growth in the face of competition from a large, integrated health care company

  • Development of a plan for joint investment in new delivery system assets to provide the marketplace with a low-cost site of care alternative

We're Thought Leaders in Payer-Provider Strategy

Payer-Provider collaboration and vertical integration in healthcare is becoming increasingly important as value-based care is now one of the primary differentiators for most medical systems.

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from-adversary-to-partner_insights-for-payers-and-providers

From Adversary to Partner: Insights for Payers and Providers

Depending on the market, organizations face increased competition from large, integrated companies—or looming pressure from new tech-savvy entrants like Amazon and Google that are unencumbered by the operating challenges and fixed-cost infrastructures of legacy healthcare providers.
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