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Data as currency in healthcare – there is a right and wrong way


Barbara Wachsman

March 7, 2022


I am honored and excited to be the first ‘guest blogger’ for Centivo.


As a longtime advisor to the senior leadership team at Centivo, I am energized by the mission and success of the company in restoring healthcare affordability and improving the delivery of healthcare for both employers and their employees.


A mega-trend I am seeing in the health benefits ecosystem is employers realizing that the utilization and cost data about their employees is incredibly valuable in driving change in the cost and quality of healthcare; in fact, you hear the term “currency” more and more as it relates to employer data and particularly in direct contracting negotiations. As an example, the other day I saw an email about a Catalyst for Payment Reform webinar with the topic “Data is the New Health Care Currency: Are Purchasers Getting Short-Changed?”


Employer’s member data treated as currency? About time! What worries me, however, is that I am seeing this currency being positioned as an ‘us vs. them’. Let me, from personal experience, explain why this is the wrong way to treat this information – and provide a model of how it should be viewed; one in which everyone has shared success and accountability for “winning”.


As most in the health benefits business are painfully aware, the big traditional carriers CANNOT give health providers employer-specific data. This as a huge weakness for carriers. Self-funded employers, however, have a huge amount of specific and valuable data about their members – far more than even the providers actually providing the care. Because of this information advantage, you can see where “us vs. them” might creep into direct contracting negotiations. But that is exactly NOT the mindset you should adopt as an employer.


First off, we in the industry need to enable and build a strong partnership between an employer and provider. It is critical physicians understand clinical needs, cost structures and access requirements, or they are just making educated guesses; something an employer just can’t afford (literally). Instead, make a strategic commitment to giving the providers as much data as they need to understand the value, and risk, of a direct relationship with you as an employer. Another way to empower the employer/provider relationship is to agree on a common source and/or set of quality metrics; in other words, a common quality ‘currency’ that allows for jointly designed and evidence-based scorecards around process measures, outcomes and the patient experience. This will allow both sides to judge both cost and quality outcomes in an objective, fact-based manner.


Reading this, you might falsely assume that following the guidelines I have just outlined is only for the truly jumbo employers who have the size, scale and other resources to make it happen. But there are options; if you are a mid-size or larger employer, you can turn to Centivo.


Centivo has built a plan based on the learnings and best practices of what was formerly reserved for jumbo employers. Importantly, Centivo is the exact opposite of the traditional carriers in that they facilitate information and data transparency. This means more than just disclosing every penny of fees and pass-through costs to the employer. It also means building a bridge between employers and providers whereby the providers are aware of, and accountable for, the population they are charged to serve; demographics, past utilization rates, chronic conditions are all disclosed and understood. And Centivo also ensures that employers understand the quality metrics and measures that providers will be held to in caring for employees and their families.


This is why I am excited to be part of the Centivo journey; by leveraging the value of information, insisting on transparency and coming to mutual agreement on what success looks like, we can transform healthcare for both employers and employees alike!


Barbara Wachsman is a former Director of Strategy and Engagement for Enterprise Benefits at the Walt Disney Company where she designed and led a direct contracting initiative with Orlando Health and Florida Hospital.  She previously worked at Towers Perrin and Arthur Andersen. During that time, she also chaired the oldest and one of the largest national employer coalitions, the Pacific Business Group on Health and remains active as a founding member and advisor to the largest employer roundtable, EHIR, the Employer Healthcare Innovation Roundtable. She is currently an advisor to Centivo’s leadership team.


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