Health systems face growing pressure to improve performance in value-based contracts while managing increasingly complex payor quality programs. Yet in many organizations, payor requirements are fragmented across contracting, analytics, population health, and clinical operations—creating attribution errors, duplicative outreach, inconsistent data interpretation, and missed performance opportunities. Sanford Health addressed these challenges by embedding payor strategy within enterprise quality through the creation of the Payor Quality Strategist role. This session highlights how this model strengthened attribution integrity, standardized payor data/reporting, and improved the usability of quality information for operations. Attendees will learn how shared campaign governance reduced waste and conflicting outreach, identifying that 56 percent of payor generated lists were clinically inappropriate.

The session also demonstrates how measure prevalence analysis across payors elevated medication adherence measures as systemwide priorities, informing workflow redesign to leverage 100-day benefit refills and support more consistent medication use. Within four months, 20,008 prescriptions were converted to 100-day fills, and standardized documentation created visibility into more than 15,000 adherence interventions. Leaders seeking practical, scalable strategies to strengthen payor partnerships, improve data trust, and drive reliable performance in value-based care will gain a clear set of structures, tools, and methods they can adapt within their organizations.

Learning Objectives

• •    Describe how embedding payor strategy within enterprise quality governance improves attribution integrity, data usability, and alignment across contracting, analytics, population health, and clinical operations.
  •    Explain the processes and governance structures used to reduce waste and conflicting outreach, including attribution review methods, shared campaign review workflows, and approaches for validating payor generated outreach lists.
  •    Identify replicable tools and workflow strategies—such as measure prevalence analysis, cross payor data standardization, and benefit prescribing—that organizations can adapt to strengthen payor collaboration and enhance value-based performance.