Reform Update: 'Physician champions' needed to increase payer, provider collaboration, execs say

It's no surprise that collaboration between payers and providers will continue to increase as the launch of health insurance exchanges in October approaches. But sustaining that cooperation will require “physician champions” to work closely with payers and more simplified contracts between the two sides, according to two health insurance executives.

Speaking at America's Health Insurance Plans Institute 2013 in Las Vegas on Wednesday, Blue Cross and Blue Shield of Minnesota Vice President Lori Nelson said that in her state, one of the key reasons for the success of programs like accountable care organizations and medical homes is the active role that providers play in quarterly meetings with the carrier.

Nelson, who oversees network management for the Minnesota Blues, said she doesn't expect provisions of the healthcare reform law going into effect next year will have any significant impact on ACOs and medical homes, except that some contracts may need to be renegotiated to make sure they take the provisions into consideration.

Marcia Guida James, director of Provider Engagement at Humana, said her No. 1 concern with payers and providers is simplifying contracts. She said one of the primary ways to facilitate better relationships between the two groups is to remodel contracts, rather than just add amendments to existing contracts.

Humana is participating in the CMS' Comprehensive Primary Care Initiative in Arkansas, Colorado, Ohio and Kentucky.

James also said that patients need to play an active role, and health information technology is “empowering patients as consumers.”

An executive who works for a company providing IT support to state insurance exchanges said that some exchange functions may not be fully automated by Oct. 1. Some of those lagging functions could include interactions between state exchange IT systems and the federal data hub, the latter of which is responsible for determining subsidy eligibility, Stuart Itkin, vice president of marketing for Calverton, Md.-based EngagePoint, told Modern Healthcare on the sidelines of the AHIP conference. Accomplishing some of those things manually is a better option than implementing an automated system that is not fully functional, Itkin said. “It's a multitude of (things) that (still) need to come together,” he said. “This is like the Golden Spike,” which symbolized the completion of the transcontinental railroad.

Speaking of IT, while Nevada is hosting the AHIP convention, the executive director of its health insurance exchange, Jon Hager, said the federal government has a long way to go on its testing of the Federal Data Hub, the IT system state online marketplaces will communicate with to determine subsidy and Medicaid eligibility. Hager said while IT implementation of Silver State Health Insurance Exchange is on time, only 20 of 100 tests for the Federal Data Hub are complete. Hager added that changes to his exchange will likely still be made after the Oct. 1 enrollment deadline. On a separate topic, Hager mentioned that in some rural areas of Nevada, there are no health plans that have expressed interest in offering plans in the small business SHOP exchanges.

(This article has been updated to correct the item about Nevada.)

Follow Jonathan Block on Twitter: @MHjblock