Payers and providers are identifying new value

Traditionally, payers and providers stayed in their lane. They had an overlap on occasion, but that was infrequently and often temporary. Payer and provider partnerships in 2020 were significant. We see a trend of coopetition. Unlikely, players realize they need to partner to increase their environmental fitness.

  • BCBS of California acquires a 2,700 physician group
  • CVS-Aetna open ~1000 drive through COVID-19 testing sites in May as part of its MinuteClinic expansion strategy. Today that has expanded to over 4800 CVS test sites
  • Optum Acquires post-acute care management platform Navihealth
  • Partners in Primary Care, the Humana-owned medical group, opens 20 new primary care centers.
  • Independence Blue Cross and CHOP enter a 5-year agreement to expand value-based care initiatives
  • Cigna partnered with Spectrum health of Michigan’s health plan. They prioritize health and increase provider access
  • BCBS of North Carolina incentivizes primary care providers with advanced, lump-sum payments to participate in BCBS’s value-based care program in 2021.

It’s evident from the payer and provider partnerships that something has changed from the days of the past. There is a renewed sense of urgency. The timeline has been compressed. Ideas that months or years ago were unheard of now are the discussion starters at leadership meetings. Unlikely partners are finding common ground by identifying shared objectives. What we’re experiencing in the healthcare ecosystem is the first private step towards healthcare interoperability.

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Peter is a technology executive with 19 years of experience, dedicated to driving innovation, digital transformation, leadership, and data in business. He helps organizations connect strategy to execution to maximize company performance. He has been recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice, driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. Peter has led businesses through complex changes, including the adoption of data-first approaches for portfolio management, lean six sigma for operational excellence, departmental transformations, process improvements, maximizing team performance, designing new IT operating models, digitizing platforms, leading large-scale mission-critical technology deployments, product management, agile methodologies, and building high-performance teams. As Chief Information Officer, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.