Manatt’s William Bernstein, chair of Manatt Health, and partner Robert Belfort were quoted by Health Data Management on how providers and payers are sharing data to manage value-based care.
The publication explains that although healthcare providers and payers have had a contentious relationship for many years, they are now collaborating to succeed under value-based care. Cooperating by sharing data is critical as the two see their financial incentives align around providing high-quality, cost-effective care.
Bernstein explained that there are transitional challenges because, for the most part, payers and providers still have “different sets of business interests.” Conflicts also arise when an initiative starts setting up sharing arrangements, because “people want to control the terms of the collaboration through being the data repository and the source of truth.”
For Belfort, wide access to claims data in a market can create antitrust concerns among providers—for example, if competing entities see the whole claim from a payer and can find out the pricing the payer is using for competitors. “Once competitors know what their respective pricing is,” explained Belfort, “they can collude with one another. Hospital A can go to Hospital B and say, ‘I see you’re getting 15 percent more than me—we should both agree to negotiate something in between what we’re getting, and we won’t undercut you that much.”
Read the article here.