title: Eight reasons payer interoperability and data sharing are essential in ACOs. Interoperability standards could be a prerequisite to measuring care.
abstract: It makes strategic and business sense for payers and providers to collaborate on how to take substantial cost out of the healthcare delivery system. Acting independently, neither medical groups, hospitals nor health plans have the optimal mix of resources and incentives to significantly reduce costs. Payers have core assets such as marketing, claims data, claims processing, reimbursement systems and capital. It would be cost prohibitive for all but the largest providers to develop these capabilities in order to compete directly with insurers. Likewise, medical groups and hospitals are positioned to foster financial interdependence among providers and coordinate the continuum of patient illnesses and care settings. Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. It is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks. Hence, it is essential to have payer interoperability and data sharing integrated in an ACO model.
authors.affiliation: Hayes Management Consulting, USA.
authors.forename: Shefali
authors.initials: S
authors.lastname: Mookencherry
mesh_terms: D060866:Accountable Care Organizations; D057286:Electronic Health Records; D007344:Insurance Claim Reporting / Q000592:standards; D008498:Medical Record Linkage; D058991:Patient Protection and Affordable Care Act; D012984:Software; D018511:Systems Integration; D014481:United States; D014584:User-Computer Interface