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By: Anna Greene on December 6th, 2022

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Becker’s Payer Roundtable Recap: Are Payviders Supervillains or Superheroes?

Health Plan Integration | Payer-Provider Integration

Of all the terms used at Becker’s Payer Issues Roundtable in early November—including Integrated Delivery Network (IDN) and Provider-Owned Health Plan—‘Payvider’ certainly had the most interesting ring to it. And, as Robert Groves, MD, Executive Vice President and Chief Medical Officer of Banner|Aetna joked in his opening remarks, he’s not sure if it sounds more like a superhero or a supervillain.

Tackling Cross-Channel Friction to Increase Efficiency.

It appears Groves and fellow panelist John Bulger, DO, Chief Medical Officer at Geisinger Health Plan are guiding their payvider organizations toward hero status. That’s because as both payers and providers of care, payviders have more room to be innovative and work through the often-challenging relationship between health systems and health plans to remove common obstacles, such as clinicians from each entity arguing over a pre-authorization and inefficient communications channels. 

Most importantly, payviders working to achieve hero status recognize that success for both sides of the house revolves not on the patient or member experience, but rather the people experience. After all, at the end of the day, patients and members are just that—people. 

Leveraging Technology to Create a Better Experience for Patients Members People.

The payvider panel was rounded out by Paul Merrild, President of Kyruus, who shared how technology can enable a more people-centric healthcare experience that creates a more unified and consistent experience across health plans and health systems. 

The root of the problem is that provider profile data can vary greatly between health system and health plan directories. That means people may find different or even conflicting information that can cause confusion if they access both directories. The depth of provider data can also vary across channels, so depending on which directory they access, people may find less robust profiles that make it difficult to choose care with confidence. 

Payviders, however, are well-structured to take advantage of technology that enables them to share provider data and even scheduling solutions, bringing greater consistency and more convenience to cross-channel care navigation. For example, Geisinger Health Plan is leveraging Kyruus’ data integration solutions to better connect the digital experiences for members and patients across the health system and the health plan. The result is richer, more consistent provider profiles across the organization’s health plan and health system directories, with increased interaction for providers whose profiles include enhanced data. Download How Geisinger Health Plan and Health Systems in its Network Enhanced How People Find the Right Provider to read the full story. 

A Unique Opportunity for Payviders

“There are some very challenging structural challenges with data and making sure people can access care in convenient ways,” said Merrild. “Payviders have a really unique opportunity to make care better for people by eliminating much of the confusion that is commonplace when a patient feels stuck in between their provider and their insurance.” Learn more from these industry leaders by listening to the Becker’s Healthcare podcast, Creating a Consistent Healthcare Experience for Members and Patients.

 

 

To learn about cross-channel connectivity, download our white paper, Bridging Provider & Payer Digital Care Navigation Gaps.