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Dr. Reetika Kumar from Independence Blue Cross (IBX) and Jeff Stuart from CHRISTUS Health sat down with Kyruus’ President Paul Merrild in Chicago a few weeks ago at the Becker’s Payer Issues Roundtable for an engaging conversation around Payer-Provider collaboration. Some key highlights from the discussion, including insights into how payer-provider collaboration can enable a better consumer experience, are below.

“We’ve got so much work to do, we can’t do it alone, we can only do it together.”
 Reetika Kumar, MD, Independence Blue Cross (IBX)

The Importance of Payer-Provider Collaboration

Payer-provider collaboration can happen in a variety of ways but one thing is clear: we can’t do without it. When we think about putting the patient first and focusing on their overall experience, it is clear that this type of collaboration has to happen. 

At the end of the day a member and a patient are the same person. And on that thread, Jeff spoke about the need to extend the work CHRISTUS Health System has done with their digital experience over to the health plan side of the business, so that when a consumer interacts with CHRISTUS Health system it is no different from the experience they have with CHRISTUS Health Plan. This cohesive experience is a benefit of payer-provider collaboration that is not limited to IDNs, however. Patients and members are looking for consistent, accurate, up-to-date information about their providers regardless of where they seek information. 

Dr. Kumar shared a particularly impactful sentiment, noting that if a health plan can realize that the TRUE healthcare relationship is between a provider and a patient, then plans can accept that their role is “to enable both parties to have a successful, seamless experience with good outcomes.” 

The Role of Accurate Data in Patient Experience

The experience that a health plan member has when searching for and booking care can set the expectations they have for what their in-person care experience will be. Both panelists spoke about the need for accurate, robust information to be displayed about providers in both system and plan directories to ensure a positive experience. 

Jeff explained that, at CHRISTUS, they realized that demographic information as basic as gender was inconsistent across their provider network. Knowing that these inconsistencies existed in their data raised some concerns around how they could expect consumers to trust them. To rectify and sort through the complex data and inconsistencies, they engaged Kyruus and Healthsparq to help. As CHRISTUS thinks through what success in this area looks like, Jeff says it’s simple: “if you are able to find a doctor and make an appointment, we are assuming that was a reflection of accurate data and that you have been able to find what you’re looking for.” 

From a clinical perspective, Dr. Kumar explained that not only do consumers want peace of mind that they are choosing a provider that is the correct match for them clinically, but they also need to trust that the provider can care for them appropriately. This points to emerging data needs that are critical to patient/member experience. Questions like: Does the physician look like me? And, do they understand me as an individual? are important considerations. She explained how race and ethnicity information can oftentimes be more difficult to capture in health plan directories as providers don’t always send it to their health plan partners. This presents an important challenge to address when working through areas of collaboration between payers and providers: identifying what data needs to be shared to go beyond checking the box and into delivering the best member experience.

The Goal: OpenTable for Healthcare

As Jeff looks to the future he is hoping that we can get to a place where healthcare can think of the consumer, member, and patient experience all more cohesively. Part of this is breaking down internal barriers to do so.

“We often hear about how behind healthcare is in terms of consumerism. Why can’t provider and payer organizations offer an amazon-like or OpenTable-like experience when seemingly every other industry has figured it out, and the consumer demand is solid?”