“EP172: The Convergence of Payers and Providers – A Critical Step Forward, Fraught With Challenges, With John Moore, CEO and Founder of Chilmark Research”
by Stacey Richter

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It’s really tough for providers to manage risk; they don’t have the necessary actuarial skills. On the other hand, providers are great at delivering care, something payers aren’t well known for. Today on the podcast, John Moore, founder and CEO of Chilmark Research, talks about the path forward for payers and providers. He said in most markets, it will be a path of convergence. Payers and providers getting together is the only way to get past some of the incredible admin costs and burdens in markets that are choking the resources in providers and across payers. John suggests, and I think this is an excellent point, that in order for this to work, payers need to invest in IT. There was no HITECH act on the payer side, so many are working with dated systems. They need to up their investment in tech platforms to provide real-time data on claims info, etc to providers that they endeavor to partner with. Click here to learn more and be sure to scroll to the end of the link for access to several Chilmark publications.

Moore, is CEO of the health care IT analyst firm, Chilmark Research, which he founded in 2007. Chilmark Research was founded on the simple premise of conducting the best research possible that will ultimately lead to improvements in the quality of care a patient receives. Having spent many years in other industry sectors, Moore has seen the dramatic improvements possible through effective adoption and use of IT and is convinced that the same can occur in health care.

A core thesis for Chilmark Research is to help guide the industry in specific subsectors of the health IT landscape by focusing on those technology domains that will be truly transformational to the delivery of care. Current areas of research include: analytics, care management and coordination, interoperability, population health management, engagement, and most recently provider-payer convergence.

Prior to founding Chilmark Research, Moore led a diverse worldwide team at Dassault Systèmes, based in Paris. As head of corporate, worldwide industry and market intelligence, he worked with the executive leadership to define key global market opportunities, forecast growth, and develop critical paths to market for its numerous software products.

Moore has held a number of other senior positions during his career including: SVP at analyst firm ARC Advisory Group; Research Associate at MIT; VP of Marketing for an analytical instrument company; and policy analyst for the Commonwealth of Massachusetts. An accomplished speaker, Moore has made numerous presentations on current and future IT trends and their impact to markets. Widely quoted in numerous publications, he has also been interviewed by: AMA News, CIO, CNBC, Computerworld, eWeek, Health Data Management, HealthIT News, InformationWeek, Investors Business Daily, US News & World Report, The Washington Post, and The Wall Street Journal.


00:00 Convergence and the delivery of health care.
02:20 “How do we deliver greater value?”
03:00 Why establishing health plans within a provider organization is often not the best idea.
04:30 How you can get around needing prior authorization and subsequently cut costs.
05:50 The motivation for a payer and provider to form a partnership.
08:00 Why consolidation doesn’t necessarily drive down costs.
08:50 Payer-provider population health management.
09:20 Understanding where the patient might be going outside of the network to get their health care.
10:00 What does it take to be good at collaboration?
10:30 “What is the opportunity here?”
10:40 “Is there a level of trust between the payer and provider?”
18:00 Advice for payers looking to partner with providers.
18:50 Look for someone wanting to deliver high-value care.
19:30 “Trust, then verify.”
23:00 New and interesting innovations coming out of current convergences.
24:00 Things still being worked out in the market today.
25:25 The innovator’s dilemma.
26:30 “How do you scale quickly?”
27:20 “Is that scalable?”
30:20 The path forward for most markets in the United States.
31:45 What Chilmark Research is and does.
32:45 Learn more by going to chilmarkresearch.com and find a free copy of the 2017 Healthcare Analytics Market Trends Report during March!

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