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Payer-provider collaboration

Every hospital and health system wants to improve the experience for their patients, but this cannot be realized until the relationship between providers and payers evolves. A central starting point for this new kind of cooperation is the mutual pursuit of administrative efficiencies.


Collaboration is a win-win — curbing expenses and boosting administrative efficiency for both parties. But while there’s value to be gained in reducing waste, the best outcome is happier, healthier patients. Consumer satisfaction can become brand loyalty and that counts for a lot: Health systems can grow only if consumers seek their services. Payers will only succeed if consumers choose their plans.

With consumer satisfaction as an end goal, we know it’s no longer simply a matter of speeding up claims processing. Forward-thinking health organizations are moving to create a new framework — and new kinds of connections — for the era of value-based care. Their first collaborative task is to eliminate the “back and forth” that has so long complicated relationships with payers — and with patients.

Sound strategies and clear communication are critical to collaboration, but so is smarter technology: By adopting computer-assisted coding and upgrading clinical documentation, health organizations can boost the accuracy of clinical and claims data — improving operations for all stakeholders and delivering the quality metrics everyone seeks. Technology also comes into play by bringing payers and providers together under a common platform where healthcare transactions can be streamlined and aggregate health data can be collected, accessed and shared in a useful and secure way.And by harnessing the revenue cycle’s data-sharing power, providers can work jointly with payers to strengthen front-end communication and back-end billing processes — while deploying analytics to stay ahead of population health risks.

Optum360® is designed to develop innovative ways to reduce the friction between payers and providers. We have deep perspective on the pressures faced by over 300 payers and deliver services to four out of five providers. Optum360 works daily to meet the growing demand for greater simplicity, value and customer satisfaction in the revenue cycle.


Optum360 expert

Peter Martin

Senior Vice President, Payer-Provider Strategy & Collaboration

“The payer-provider relationship can now be re-established — built on trust, transparency and data. Optum360 can enable trust and support new decision-making based on data. This drives more transparency and greater simplification and enables more conversations around fee-for-value models. This shifts it from a relationship to a partnership.”

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