How Vytalize Health’s Payer Contracting Team Bridges the Payer-Provider Gap

Article | 06/15/2023

‍Currently, there are about 55.8 million U.S. citizens aged 65 and older, and by 2030, the entire baby boom generation will be eligible for Medicare. With this projected growth comes an immense opportunity to make a lasting impact on the lives of older adult patients.

We talked to Vytalize Health’s Payer Contracting team about how the company works with different payers to empower providers and ensure healthier lives for their patients.

Check it out.

Who are our payers?

Vytalize works with two types of payers to ensure access to high-quality care for patients aged 65 and older: government entities, like the Centers for Medicare and Medicaid Services (CMS), and private payers, including large national payers and smaller regional and local payers. While Vytalize works with CMS on the ACO front, private payers exist in the Medicare space with Medicare Advantage (MA) as their product. According to newly released data from CMS, Medicare Advantage now provides Medicare coverage for over half of their eligible beneficiaries.

How do we work with private payers?

While both kinds of payers are regulated, private payers are more profit-oriented, which means they contract in a different manner. Chief of Payer Contracting, Ken Stoll explains that Vytalize helps private payers by optimizing clinical resources and incentives to support providers and their practices. Private payers can focus on growing their insurance business, while healthcare organizations like Vytalize take on clinical management and help to reduce provider burnout.

What are the goals when working with different payers?

Value-based contracts are evolving and becoming more and more complex. Vytalize is in a great position to help private payers, and providers improve their relationships and collaboration. Essentially, no matter the payer, Vytalize’s focus remains the same—ensuring physicians are empowered to make the best decisions that allow them to provide the best medical care. Similar to the ACO space, with Medicare Advantage, Vytalize serves as a bridge between the payer and provider, helping them to understand the demands each has on their practice and business, as well as on their patients. Our partnership with both manages risk for insurance companies and increases patient access and provider support, allowing better patient care.

As the Medicare population continues to grow, so do the expectations and responsibilities of payers and providers. It has never been more crucial for facilitators like Vytalize to coordinate with both and to effectively and impactfully address the needs of the most vulnerable patients. If you are a provider looking to improve your relationship with payers, contact Vytalize here to learn how we can best support you.