The healthcare sector is undergoing a significant transformation as organisations strive to provide better outcomes while reducing costs. One emerging solution is the "payvider" model, which integrates healthcare services with insurance coverage. By combining these traditionally separate functions, the model aligns incentives, enhances coordination and prioritises value-based care. Through advanced technology and operational integration, payviders aim to create seamless experiences that improve patient outcomes and operational efficiency. Leading examples such as Sentara Health, Geisinger and Banner|Aetna highlight how this innovative model is shaping the future of healthcare.
Leveraging Technology to Drive Integration
Technology serves as the cornerstone of the payvider model, enabling healthcare organisations to unify disparate systems and processes. Sentara Health has demonstrated the potential of such integration by adopting a cloud-based infrastructure. Sentara has achieved a unified view of its customers across care and insurance operations by migrating workloads to Microsoft Azure and creating an enterprise data platform (EDP). This comprehensive data framework supports advanced analytics and personalised customer service. For example, predictive tools enable Sentara to intervene early in patients’ health journeys while optimised prior-authorisation processes reduce delays in care delivery and associated costs.
Geisinger, another forward-thinking organisation, has embraced digital transformation to improve its customer experience. By developing a unified portal, it has simplified access to healthcare services and insurance information. Previously, patients and members needed separate logins for these functions. Now, the integrated portal offers single sign-on functionality, providing users with a seamless interface for managing care and benefits. This enhances convenience and supports Geisinger’s broader goals of improving accessibility and patient satisfaction.
These advancements exemplify the vital role of technology in enabling payviders to bridge gaps between care delivery and insurance. By consolidating data and automating processes, organisations can drive efficiency, reduce administrative burdens and focus on delivering better care.
Enhancing the Patient and Member Experience
The payvider model is inherently customer-centric, seeking to eliminate the pain points often accompanying healthcare and insurance interactions. Banner|Aetna, a collaboration between Banner Health and Aetna, has pioneered efforts to simplify processes and improve satisfaction. One of its standout initiatives is the implementation of a frictionless billing system, which integrates insurance and provider billing information into a single, easy-to-understand statement. This innovation addresses one of the most common complaints in healthcare—confusing billing processes. By creating a unified statement, Banner|Aetna has significantly reduced patient confusion and enhanced transparency.
In addition, Banner|Aetna has adopted cloud-based case management tools that unify health and insurance data, providing staff with a comprehensive view of patients’ needs. These systems enable more precise and proactive care interventions. For example, algorithms and analytics identify high-risk or high-cost members, allowing nurse case managers to deliver targeted support. This level of personalisation not only improves health outcomes but also strengthens the relationship between patients and their healthcare providers.
Sentara Health and Geisinger have also focused on improving the customer experience. Sentara’s integrated customer relationship management (CRM) systems provide call centre staff with complete access to patient and member information, enabling them to offer tailored assistance. Meanwhile, Geisinger’s new portal enhances digital engagement, ensuring users can navigate their healthcare and insurance information with ease. These efforts reflect the broader aim of payviders to create optimised, user-friendly systems that prioritise patient and member satisfaction.
Advancing Value-Based Care Through Integration
The payvider model is deeply aligned with the principles of value-based care, which emphasises improved health outcomes and cost efficiency over the traditional fee-for-service approach. By integrating care delivery with insurance, payviders create a structure that rewards coordination, prevention and early intervention. This alignment of incentives is critical in addressing rising healthcare costs and improving population health.
Sentara Health’s automated prior-authorisation system exemplifies how payviders can optimise resources to support value-based care. By automating approvals for common services and prioritising staff efforts on complex cases, Sentara reduces delays while ensuring that resources are focused where they are most needed. Similarly, Banner|Aetna’s use of analytics to identify high-risk patients allows for timely and effective interventions, preventing complications and reducing long-term costs.
Geisinger’s approach to integration further underscores the potential of the payvider model to drive value-based care. By creating a unified portal and consolidating patient and insurance data, it empowers users with a clear and cohesive view of their health and benefits. This transparency and accessibility enable patients to make informed decisions, fostering a sense of engagement and accountability in their care.
As the healthcare industry moves towards value-based care, the payvider model provides a scalable and sustainable framework. By leveraging technology, integrating operations and prioritising preventative care, payviders are well-positioned to deliver superior outcomes at a lower cost.
The rise of the payvider model marks a significant shift in how healthcare is delivered and financed. By combining the functions of care delivery and insurance, organisations like Sentara Health, Geisinger and Banner|Aetna are demonstrating how integrated systems can improve outcomes, reduce costs and enhance patient experiences. Central to this transformation is the use of advanced technology, which enables data unification, process automation and personalised care.
Through these innovations, payviders are redefining the healthcare landscape, moving away from fragmented systems towards a holistic approach that aligns with the principles of value-based care. As more organisations embrace this model, its potential to create a more efficient, patient-centred healthcare system becomes increasingly apparent. The future of healthcare lies in integration, and the payvider model stands as a testament to what is possible when care and coverage work in harmony.
Source: HealthTech
Image Credit: iStock
