Negotiating the Future: Contracting Insights from Industry Leaders
A conversation between Lee McGrath, Executive Vice President of Healthcare Services at Premera, and Dr. Imelda Dacones, Market President of Optum Pacific Northwest, focused on recent headlines about contract negotiations between healthcare systems and health plans.
“I think when someone holds a Premera ID card or really any insurance card, they’re expecting access and when access is threatened, our customers get stuck in the middle,” McGrath said. “We have to continue to do better and be better, understand the needs of the provider community, the payer community, the employer group, as well as the needs of the individual customer.”
Reliable access to care is a cornerstone of the patient-provider relationship. The rapport and trust built over time are key to effective treatments and patient satisfaction. Public contract disputes threaten peace of mind for both providers and patients, damaging the hard-earned sense of stability and trust that comes from long-term provider relationships.
“I’m in a profession where I took an oath, and putting patients in the middle of this is causing avoidable stress, avoidable angst, and avoidable confusion,” said Dr. Dacones.
As McGrath pointed out, “Terminations also come with double-digit increases and that doesn’t help affordability at all.”
What is a viable solution then? Dr. Dacones sees this point of tension as an opportunity for all parties—payers, providers, and policymakers—to push the pursuit of value-based care to the forefront.
Value-based care is a payment model that rewards healthcare providers for achieving better outcomes and healthier patients. This is a shift away from the traditional fee-for-service model that is based only on the number of services provided.
Recognizing the importance of transparent, good-faith negotiations, Premera is working to bridge the divide between healthcare systems and health plans, ensuring that our members can always access quality care from the providers they know and trust without the burden of uncertainty, financial or otherwise.
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