EP417: 5 Kinds of Payer and Provider Collaborations and 5 Must-Haves for Said Collaborations to Work, With Josh Berlin, JD

Most payer-provider relationships aren't collaborative — they're fairly adversarial, especially from the standpoint of provider organizations trying to find a payment model that lets them actually do right by patients. In this episode, Stacey Richter talks with Josh Berlin, JD, CEO of Rule of Three, about the real why, what, and how of payer-provider collaboration: what actually motivates a payer to collaborate (since payers other than in their fully insured book are just intermediaries, not the ones bearing the risk), the five distinct kinds of collaboration that exist, and the five must-haves that determine whether any of them actually work.

WHAT YOU'LL LEARN

✅ Why "saving money" alone isn't actually a compelling reason for a payer to collaborate with providers — and what genuinely motivates payers instead: predictable spend, competitive differentiation, market resilience, margin, and Star Ratings/HEDIS-linked dollars

✅ The five kinds of payer-provider collaboration, ranked by depth of entanglement: sharing data, joint programmatic work like clinical pathways, joint ventures on narrow-network products, becoming capital partners, and full risk-bearing relationships where the provider gets a piece of the premium dollar

✅ The five must-haves Josh Berlin says any collaboration needs before it starts: complementary, scalable capabilities; shared goals and time horizon; flexibility on both sides; genuine skill at collaborating (not just stated intention); and compatible risk profiles

✅ Why "you have to be collaborative to collaborate" sounds obvious but is frequently an unexamined blind spot inside payer organizations — and what it actually looks like when a payer isn't

✅ Why Ochsner stands out as a real-world example of payer-provider collaboration working, and what a notable collaboration failure like Haven can teach about what goes wrong

WHY THIS MATTERS

Payer-provider relationships default to adversarial not because collaboration is impossible, but because most attempts skip the unglamorous prerequisites: shared goals, real flexibility, and the actual cultural capacity to collaborate rather than just the stated desire to. Josh Berlin's five-and-five framework gives both sides a concrete way to diagnose whether a proposed collaboration is set up to succeed before committing real time and capital to it — which matters, because plenty of providers and payers who've tried this confirm just how rare and hard-won a functioning collaboration actually is.

MENTIONED IN THIS EPISODE

EP359 with Dan O'Neill: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

06:06 Why should payers want to collaborate with providers?

09:46 "Collaboration … is bilateral. … Both sides, plan and provider, should be equally as interactive with the individual populations they work with."

12:37 What are the must-haves for collaboration between providers and payers?

13:10 What are the five different types of collaboration?

16:03 What are the five characteristics you want to be focused on in partnership?

22:16 In order to collaborate, do you have to be collaborative?

26:11 Ochsner as a great example of collaboration.

27:46 Episodes with David Carmouche, MD, and Eric Gallagher.

28:51 A collaboration failure in Haven.