What is a Payvider?

Payviders, a combination of payers and providers, refers to organizations that both deliver health care and finance health benefits. It’s essentially a buzzword for the health care version of vertical integration. Payviders are not new – Kaiser Permanente is probably the most well-known example – but the topic resurfaced in a big way with the release of Guidehouse’s report that found the U.S. market “ripe for payvider adoption and growth.”

According to Guidehouse, the strategic importance of payviders grew with the need for risk-sharing and value-based care models along with the increase in Medicare Advantage and Medicaid managed care. Payviders have the potential to disrupt the industry by spending less time negotiating prices and more time working together, putting clients at the center of care through digital innovation, and creating data-driven systems.

The dominant form of payviders in today’s market is through an acquisition of a health plan or provider. Examples include:

• One Medical’s acquisition of Iora Health, a Medicare Advantage plan
• Optum’s acquisition of Davita Medical Group
• CareSource’s acquisition of the Columbus Organization which serves the intellectual and developmental disability and behavioral health population

Payviders don’t just have to be a result of acquisition but can include partnerships as well. These can take the form of accountable care organizations, risk-bearing arrangements, and data-sharing agreements. Examples include:

• Humana’s value-based partnership with Allina Health, a health system in Minnesota. Payment will be tied to patient outcomes and Allina Health will have access to Humana’s data analytics and other technologies.
• Aetna extended its partnership agreement with Banner Health, a health system in Arizona, in February 2021 after realizing cost savings of 8-14%.

HOW DOES THE PAYVIDER AFFECT BEHAVIORAL HEALTH?

In the past, the payvider trend was largely focused on physical health, but the trend is picking up in behavioral health. Leaders of behavioral health organizations must position themselves to either become a payvider or compete with payviders.

Regardless of the strategic positioning a behavioral health organization chooses, technology will be at the center of success. The use of technology boils down to two needs: the data to demonstrate value and the ability to share data.

The Data to Demonstrate Value: For behavioral health organizations, demonstrating value can be particularly difficult due to the nature of the field. Proxy measures such as decreased use of emergency rooms or follow-up after hospitalization are often used to demonstrate value but do not get into the heart of behavioral health treatment.

Systems like Eleos Health can overlay on top of existing technology to deliver answers on clinical performance through voice-based technology insights. Organizations can use the data from these systems to show their adherence to evidence-based practices, change in client severity, and quality of the therapist’s response. When those insights are combined with key quality metrics, providers can tell a compelling story about their value.

Ability to Share Data: On average, the typical person with a behavioral health condition has 4-5 different providers such as a therapist, primary care doctor, psychiatrist, case manager, and nutritionist. Data silos exist between these providers due to technological barriers and privacy rules which results in duplicative tests and a lack of consideration of the whole person.

The ability to share data not only allows for better care coordination but potentially allows for providers to partner with payers on data sharing. The additional access allows for better care coordination and identification of potential problems.

Payers want partners who can easily adapt to their technology systems to suit the needs of the partnership. While transforming agency technology can feel like a major lift, the benefits go beyond appealing to a potential payer partner. Transforming technology can improve workflows, provide a better experience for clients, and demonstrate organizational value to the community.