Multi-Payer Alignment

Defining key terms:
Payers: Groups responsible for paying health care providers, including private health insurers and government programs like Medicare and Medicaid. Multi-Payer Alignment: Refers to the coordination and collaboration among health insurance payers to meet common health care delivery goals and patient outcomes, like improving quality of care and reducing administrative burden. Examples might include aligning on certain performance measures and reporting metrics, health equity standards, how payments are calculated, or data sharing.

Defining key terms:

Payers: Groups responsible for paying health care providers, including private health insurers and government programs like Medicare and Medicaid.
Multi-Payer Alignment: Refers to the coordination and collaboration among health insurance payers to meet common health care delivery goals and patient outcomes, like improving quality of care and reducing administrative burden. Examples might include aligning on certain performance measures and reporting metrics, health equity standards, how payments are calculated, or data sharing.

What is Multi-Payer Alignment?

The health care system is comprised of several groups responsible for paying health care providers. These payers include private health plans and government programs like Medicare and Medicaid. When multi-payer alignment is achieved, payers operating in the same area may follow the same policies, such as:

Performance measurements and reporting
Quality measures
Strategies to advance health equity
Rewarding specific health outcomes
Payment approaches
Data-sharing, learning and technical support

The specific policies that payers align on can be flexible based on the needs of a group of providers, or the needs of the populations they support.

The CMS Innovation Center helps insurance payers identify policies that would benefit from alignment in a value-based care health care system. CMS also provides tools for participants in the CMS Innovation Center’s pilot programs, like claims data (including information on appointments, bills, insurance, and patient-provider communications), data analysis, and learning groups to help support these changes.

Why Multi-Payer Alignment is Important

Multi-payer alignment makes it easier for providers to deliver value-based care by reducing administrative burden and allowing providers to spend more time delivering care to patients. It ensures consistency across certain business aspects of practices like billing, payment, and clinical documentation systems.

Additional benefits of multi-payer alignment include:

Advancing health equity. Reducing the differences in access to care based on insurance type can create a more equitable health care system for all patients to get high quality care, through features like aligned health equity plans, and expanded access to value-based care.
Improving population health. When insurance payers and health care providers agree on the same goals and care standards, they can work together to advance preventative care or manage specific chronic conditions. This improves individuals’ health outcomes and can also lead to healthier populations over time.
Lower administrative costs. Multi-payer alignment an reduce administrative expenses through use of common payment methodologies.
Access to more data. When health care providers can see all claims data from different insurance companies in one place, they are more likely to use patient records to inform clinical decisions.

Multi-Payer Alignment in Action

The following is hypothetical example of multi-payer alignment’s potential impact:

A rural population has limited health care resources with few doctors, no local hospital, and high rates of chronic disease. Multiple payers offer health plans in the region, but payers do not communicate well with each other. As a result, practices may experience higher administrative burden, and additional challenges in delivering care and being reimbursed for care delivered, leading to possible gaps in care, and delays accessing services. Local health care providers report they feel overwhelmed by inconsistent payment rules, quality programs, and reporting requirements.

To address these challenges, the payers in the region – Medicaid, Medicare, and private insurers – decide to work together to set aligned goals and common measures for care delivery and outcomes, including improving access to care and chronic disease management for patients. They also aim to lighten the administrative burden on local providers by using common billing and payment methodologies and aligned reporting requirements. To support practice’s clinical improvement efforts, payers agree to make their data available in a single, aggregated report to provide insight into how patient care can be better managed.

Following the implementation of a multi-payer alignment strategy, patients report easier access to health care. Health outcomes improve due to the chronic disease management program and there are fewer hospital admissions. The simplified billing system allows providers to spend more time providing direct patient care. Multi-payer alignment helps stabilize health care costs and contributes to improving the quality and consistency of care for the population.

Additional Information

CMS Innovation Center models that incorporate multi-payer alignment include:

To learn more about multi-payer alignment and the future of value-based care:

Innovation Center Strategic Direction
Blogs and Publications
Health Care Payment Learning and Action Network (LAN) : An active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system’s adoption of alternative payment models.