Changing the Payer – Provider Relationship

Photo credit: Les Finances

If I asked you where you would expect better information sharing practices — a major healthcare network or a veterinarian network — which would you choose? The answer may surprise you, and it’s one of the reasons I’m so passionate about interoperability in healthcare.

I experienced both the benefit and lack of interoperability in modern healthcare. I saw the power of interoperability when my dog, Thor, was in an accident and taken to the nearest emergency care facility. Before I could share his health history, the vet already accessed his records and knew everything he needed to provide the necessary care.

Alternatively, when my grandmother was injured while on vacation and taken to the emergency room at a facility affiliated with her primary care physician (I purposefully chose this hospital for that reason!), her records were not accessible. Once she returned home, the records from her ER visit were not available to her doctor, leading to duplicate testing and a delayed diagnosis. Despite making all the right decisions in where to bring her, the same seamless care experience Thor had was not available to my grandmother.

I’d like to think that my grandmother’s experience was outside the norm, but it isn’t. More often than not patients don’t receive the level of care needed due to a lack of access to information.

At the InterSystems Healthcare Leadership Conference at Global Summit 2019, I spoke about my frustration that Thor had a better care experience than my grandmother. How is it that, despite having unprecedented access to in-depth data on patient history, today’s healthcare system is still at a loss for the best way to share that information?

Payers like Premera are in a prime position to prevent situations like the one my family faced when trying to get my grandmother the help she needed. Payers have access to information about all the tests, diagnoses, and care delivered to their members. They have advanced analytic and machine learning capabilities that can help process that information and use it to identify care gaps, improve risk assessments, and improve relationships with providers.

Improving the flow of information across the healthcare ecosystem is not a problem that any single payer, provider, or even technology provider can solve alone. It requires a concerted effort from the entire healthcare industry to open the lines of communication. Working with our partners, such as InterSystems, enables Premera and other payers to be part of the movement to improve the overall patient experience and revolutionize how payers, providers and patients interact moving forward.

I want to be part of the solution that leads to better care experiences, not one of the obstacles to it. My hope is that more players in the healthcare space will have the conversations necessary to make seamless interoperability the norm — and not the exception.

Headed to HIMSS20? Don’t miss Premera’s Industry Solution Session: Breaking Data Silos to Make Healthcare Work Better.

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About the Author

Sherry Wilson is a psychotherapist with 17 years case management experience supporting members with complex health conditions while they navigate challenges within the healthcare system. Sherry is skilled in clinical practice, data management, teaching and staff development, system management and work-flow design, change management and implementation management.

In her current role at Premera Blue Cross, Sherry bridges data and technology with clinical practitioners and advocates for the best patient car by integrating payer and provider data into a comprehensive patient health record.

Guest Blogger

InterSystems blogs are authored by members of the InterSystems team as well as guest bloggers. Our blogs will provide a range of opinions that we hope you will find useful, engaging, informative – and fun to read.

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  1. Christine Wilson

    February 21, 2020

    This is a great story and needs to be told many times over until we get message through