The Payor-Provider-Patient Trio: a balancing act in healthcare

Priyanka Vaidya
Chief Product Officer
at Delfina
min read

In the world of healthcare, a balance must be maintained among three crucial stakeholders: payors, providers, and patients. This interplay, often referred to as the Payor-Provider-Patient trio, shapes the landscape of healthcare delivery, costs, and quality. In this blog post, we'll dive into the dynamics of this trio, its impact on the healthcare ecosystem and how Delfina is working to thread the needle to meet the discrete requirements of each of these stakeholders.

1. Payor

Payors, which include insurance companies, government programs like Medicare and Medicaid, and even individuals paying out-of-pocket, play a pivotal role in the trio. They are responsible for financing healthcare services. Payors negotiate contracts with providers, establish reimbursement rates, and set coverage policies. Their primary goal is to manage costs while ensuring access to quality care for their beneficiaries. At Delfina, we work with payors to ensure that as many patients as possible can gain access to Delfina Care at no cost to them.

2. Provider

Providers encompass hospitals, clinics, physicians, nurses, and other healthcare professionals. Their role is to deliver medical services to patients. Providers are influenced by various factors, including the payment models set by payors, regulatory requirements, and their commitment to patient care. Their mission is to offer effective and compassionate care while navigating complex reimbursement systems. At Delfina, we partner with our providers to ensure new models of care can seamlessly integrate with their daily workflows and enable them to provide the highest quality of care to their patients.

3. Patient

At the heart of the trio lies the patient, who seeks medical care and relies on both payors and providers for their well-being. Patients have diverse needs and expectations, including access to affordable care to personalized treatment plans. In an ideal scenario, the patient's interests align with those of payors and providers, resulting in optimal healthcare outcomes. At Delfina, we have designed a patient-centered model of care, identifying social and clinical needs and addressing them using our Delfina Care program and allied services.

These three stakeholders all interact in various ways, driving the healthcare system.

For a company like Delfina, who exists outside of the trio, we strive to design with all three stakeholders in mind. Here are some key dynamics we keep in mind:

- Cost vs. Quality: Payors strive to control costs, which may conflict with providers' care delivery goals. Striking a balance between cost containment and quality improvement is a constant challenge with often opposing incentives.

- Patient-Centered Care: The healthcare industry increasingly emphasizes patient-centered care, where patient preferences, values, and needs are at the forefront of decision-making. This shift requires collaboration among all three stakeholders.

- Information Exchange: Effective communication and data sharing among payors, providers, and patients are crucial. Electronic health records (EHRs) and health information exchanges (HIEs) aim to facilitate this exchange, improving care coordination.

- Value-Based Care: Payors are transitioning from fee-for-service models to value-based care arrangements, with maternal health as the next frontier. In these models, providers are incentivized to focus on patient outcomes rather than the volume of services provided, aligning interests more closely with those of patients and plans.

The Payor-Provider-Patient trio is a complex ecosystem that is constantly evolving as new models of care emerge. In order to create change within the healthcare system, we focus on creating a product that clearly creates value for all three parties—and ultimately results in the best care for patients. 

At Delfina, we work with all members of the trio in order to make quality care affordable and accessible to as many pregnant patients as possible. If you’re interested in partnering with us, please reach out.

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