Examining care and coverage in academic health systems

A new study published in Population Health Management, which builds on previous work in the journal, describes the Academic Payvider model, a joint approach to care and coverage aimed at reforming the relationship between payers and providers to enhance value-based care.

“There is an undeniable need for reformation of the relationship between health care payers and providers,” states Erika Harness, MHA, from the Sidney Kimmel Medical College at Thomas Jefferson University, and co-authors of the study. The Payvider model is one promising approach, with the partnership model of shared ownership considered to be the most effective. The current study examines “Academic Payviders,” a term that describes academic health systems that provide health plans to patients.

The investigators reported rapid growth of Academic Payvider systems within the last two decades. “The growth of Academic Payviders is stimulated by ongoing policy and market factors,” stated the investigators.

“Ultimately, this shift in payment models can aid patients and providers alike. The patient experiences benefit from improved coordination and integration, reduced insurance hassles, and increased staff attention to ensuring optimal outcomes. Simultaneously, providers experience reduced administrative burden and burnout.”

In an accompanying editorial, Josh Berlin, Chief Executive Officer of Rule of Three, LLC, writes, “Whether the Academic Payvider is the or an answer to an industry fraught with challenges remains to be seen.

“The underlying paper notes the sample size is still relatively small by comparison to the quantity of academic institutions serving health care overall. Nevertheless, these relationships bring inspiration for the art of what is possible to drive complex, higher cost care down through innovative payment and reimbursement structures more effectively and efficiently managed with the expertise of such unique collaborators.”