There’s a tricky dynamic in healthcare that Terry Shaw calls “margin stacking.” Everyone involved in care delivery—payers, providers, suppliers and other stakeholders—has to make money. The more players involved, the taller the stack. That’s why healthcare’s so expensive.
Shaw’s panel touched on the importance of not only resolving the often combative nature of relationships between payers and providers, but of developing partnerships in which they work together. Panelists suggested doing so will be necessary to succeed at lowering the cost of care.
Seated beside Mario Schlosser, the CEO of technology-focused insurer Oscar Health, Shaw said meaningful partnerships will allow providers to do more connecting with their customers, especially in the outpatient setting, which he admitted systems are “horrible at” currently.
“Mario has a lot of tools that we don’t have,” Shaw said. “What can I do to partner with Mario to get done what I need to get done?”
Laura Kaiser, the CEO of St. Louis-based SSM Health, agreed that cross-sector partnerships will be key.
“Many times we apply current thinking, current problem-solving techniques to something that needs different problem-solving techniques and different ideas,” she said. “It’s wonderful that people like Mario are coming in to disrupt us and be part of the equation.”
Patients will be the real winners once that happens, Schlosser said. Most of Oscar’s members still get five different medical bills. In the future, he wants them to get just one, which they’ll pay at one place.
Partnerships also cut down on the costly back and forth between payers and providers. Schlosser shared the example of Oscar’s plan with the not-for-profit academic medical center Cleveland Clinic, in which risk is split 50-50. After just a few months, prior authorizations dropped 73%, or about 10,000 fewer prior authorizations, Schlosser said.
“It’s a little bit silly why we all can’t try to optimize this flow,” he said.