Over the years, Fairview has expanded its payment models to include pay-for-performance with commercial payers and gain sharing with the Minnesota Medicaid program. Today it has more than 306,000 risk-based members that account for 60% of Fairview Health Services patient revenue
4.Get the information you need
A successful payer-provider relationship requires the exchange of a lot of data. Unfortunately payers may have different levels of capabilities. McCoy explains that Fairview's payers have invested varying amounts of their resources into the creation of their analytic capabilities to help identify at-risk members and cost variations so we can "identify potential areas of improvement."
Fairview has begun to implement payer penalties for non-performance in providing timely data with enough actionable detail. "Payers may have different priorities we are beginning to build this penalty into our contracts."
5.Avoid overlapping duties
For years health plans have performed some level of disease/care management. Providers are now taking on that function and as a result some overlapping may occur. McCoy says it is important to coordinate to make sure resources are used in the areas where "we'll have the most success impacting member care."
The payer-provider ACO partnership holds the promise of improving population health and lowering healthcare costs. It is a difficult proposition but both sides have developed insight into the systemic changes necessary to succeed. Sharing the information is part of the process.