Payers + Providers: What I Didn’t Know Then

Insights posted on 6-26-2018 by Melinda Gales

I remember the first time I had to make my own decision about selecting a healthcare plan. It was overwhelming for a young woman just out of college. Happily, the benefits person at my office was very helpful and most of my following experiences with what the healthcare ecosystem calls “payers” has been positive however, very separate from what I considered healthcare. I never imagined decades ago that today, my health plan payer would be involved in keeping me healthy or be sharing risk with one or more of my providers.

Welcome to now.

Today, employers are as likely to offer employees a plan they have negotiated specifically for their employees, as they are to purchase a traditional ‘off the shelf” option or one where your provider may be at risk for your health. You can even have your bill paid by an aggregator of provider services offered at fixed fees (like MDSave).

If you’re in healthcare, you must understand this changing provider/payer landscape is a true catalyst for innovation. At Virsys12, we’re deep into how great technology for providers — can also be great technology solutions for payers.

This week, Salesforce announced a version of Health Cloud for Payers. Hope you will take the time to read about it and notice Virsys12 was recommended for our work in this area. Does that mean we don’t focus on providers? Not a chance. Because as I mentioned before, providers and payers are no long opposite sides of the coin. They are overlapping Venn diagram circles and have more of a dependent relationship than ever. Gartner research designated Virsys12 a “Cool Vendor” in March, much of that recognition was for our proprietary V12 Network application that tracks and automates the various data points and processes needed to manage a risk sharing model between payers and providers, as well as the traditional fee for service.

Also his month, in a Gartner note: Medicare Advantage Regulations Force Provider Network Management Technology Upgrades, analyst Bryan Cole mentioned Virsys12 as one of two vendors to implement CRM as a foundation for workflow coordination and provider data validation. The ‘many to many’ relationships nature of CRM (and we use Salesforce, the #1 CRM) makes it possible to connect and cross tab data at lightning speeds for an efficient operational platform to accelerate care to the patient. Maybe a patient like you or someone you know. That makes us proud.

So…to my younger self, don’t panic, it may be confusing but fast forward to 2018 and many people (including you/me) will be effectively offering technology solutions to keep people well longer, to be treated faster when care is needed, and supporting the patient journey to end with better outcomes at a lower price. Now that is a future I’m glad to be in. Aren’t you?

Want to know more? Go to Virsys12.com, call us at 615) 800 – 6768 or email us at solutions @ Virsys12.com.