Innovation Trends

Payer-Provider Collaboration Can Improve IT Requirements & Meet Compliance

In my previous blog post regarding ICD-10, I made the comment that the right hand feeds the left—referring to how payer-provider collaboration can increase efficiencies around ICD-10 remediation.

ICD-10 is not the only compliance initiative that can benefit from bi-directional payer-provider collaboration. The reality of today, is both entities are faced with a myriad of compliance initiatives that intersect. Any or all of these intersections can turn chaotic, and fast.

If not managed properly it can potentially divert tasks at hand—impacting deadlines, project cost overruns, errors or bugs in the systems, gaps subjecting them to the risk of regulatory fines or even data breach events and expensive privacy/security remediation.

The complexity of these intersections needs organization that can only come from clear goals and collaboration—internally and externally.

Collaborating in the context of each compliance initiative can better define the IT requirements to build or renovate the right systems, define when, where or if they intersect, how and by what deadline. Increasing efficiency across transactional intersections, eliminating duplication of processes, and saving money.

As one example, AETNA is one of the progressive insurers running focus groups with their provider partners for the sake of building the right requirements into their provider portal. They understand building what AETNA wants—siloed decisions—won’t improve the quality of the IT build, transaction processes or related costs.

Collaborating with specific context to their provider portal—is one step in the right direction. This payer-provider relationship can be elevated now to ICD-10, ACO, HIE or any other IT-driven initiative.

Advocate Health Care, the largest hospital system in Illinois, and Blue Cross Blue Shield of Illinois (BCBSIL) are declaring some early successes with its provider-payer accountable care organization, which is the largest commercial ACO thus far. Their collaboration thrust them into the forefront of this major initiative.