Points of Light 2022
Recognizing Successful Payer/Provider Collaborations

A note about award methodology: Points of Light awards are given to payers, providers, and IT vendors who demonstrate close collaboration that leads to shared outcomes. KLAS validated submissions via a standard set of questions administered during in-depth interviews with representatives from all relevant stakeholders.

Prior authorization: Obtaining prior authorization for medications, imaging, and procedures can be a significant source of administrative inefficiency as well as patient frustration, and it was the most common area of focus among this year’s award winners. The partnerships that focused on streamlining this process leveraged strategies such as artificial intelligence, clinical decision support, and improved interoperability.

Value-based care: Achieving better outcomes and lower costs requires improved data exchange that allows provider and payer organizations to understand their patient/member populations, provide needed care management, and close gaps in care. It also requires both provider and payer organizations to develop new operational and financial knowledge to effectively sustain bundled-payment programs.

The Role of Technology Partners

The variety of technologies that collaborators are using to reduce friction speaks to the complexity of the task at hand and the fact that there are often multiple options for achieving outcomes. KLAS’ hope is that examining these options will help other organizations identify technologies that might be helpful in their own strategies. Which option is best will largely depend on the collaborators’ resources, budgets, relationship, and timeline. The table on the next page outlines the specific challenge each group of collaborators was trying to solve, the action plan created, and the technology implemented to support it.

Points of Light: Top Outcomes Achieved through Collaboration

The collaborations highlighted in this report have achieved a variety of outcomes, the most common being improved efficiency in the administrative tasks between payer and provider organizations as well as positive financial results.

Cultivate an environment of trust

Clearly outline your definition of success

Create the people and governance structures necessary for success

Understand what your technology partner can (and can’t) offer

• Build trust through frequent, transparent dialogue and structured, intentional collaboration
• All parties must be committed
• Let go of past narratives that may exist regarding the payer/provider relationship

• Create a clear, concise definition of success
• End goals must be win-win scenarios (i.e., use cases that have value) for all involved parties
• Start small—decide what phase one will look like and then scale up
• Don’t be afraid to reevaluate as needed

• To ensure rapid adoption of technology, create a governing council with provider representation
• Adjust the organizational structure as needed to carry out new processes successfully
• Involve key stakeholders early on—it may be critical to have a dedicated team, physician champions, an operational owner, or staff expert liaisons (for provider and payer communication)

• Choose a technology partner that brings all stakeholders to the table
• Technology vendor must understand any relevant regulatory requirements (e.g., those for value-based care or revenue cycle
• EMR vendors may need help understanding the back-and-forth that happens between payers and providers