Third-Party Payer Revenue and Operating Model Integration: Provider and Payer Collaboration Strategies

Guidehouse's Christopher Kalkhof and Richard Bajner Author HFMA Magazine Article

Since the introduction of the Affordable Care Act and various Medicare and state Medicaid reform initiatives in recent years, healthcare organizations have engaged in innovation and experimentation around payment and care delivery models.

In almost every case, these innovation models share the following primary goals:

  • To redesign and transform clinical care and payment models across a patient's entire episode of care, encompassing all care delivery settings
  • To develop, capture, and deliver value for the purchasers and users of healthcare services as the outcome of clinical and operational redesign and transformation processes
  • To further evolve into an economically sustainable, value-based enterprise

A critical building block for this transformation is for providers and payers to move from transactional and purely contractual relationships to building payer provider partnerships that are strategic, durable, long-term, and allow for the creation of product differential and cost advantage value for both parties.

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