Building Payer-Provider Partnerships for a Stronger Health Ecosystem

Payers and providers have long eyed each other with suspicion, but a growing cohort of health system leaders say that adversarial dynamic is killing value-based care before it can work. The session “Radical Collaboration: Building Payer-Provider Partnerships for a Stronger Health Ecosystem” at the NAACOS Spring 2026 Conference brought together leaders from 3 provider organizations (InnovaCare Health, Astrana Health, and Millennium Physician Group) to discuss the practical realities of building productive payer-provider relationships across Medicare Advantage (MA), Medicaid, and commercial lines of business.

The Case for Partnership Over Adversity

Moderator Robert Millette opened with a direct framing and noted that treating payers as adversaries is not a strategy. With 30 years in health care finance, he argued that providers need to stop positioning themselves in opposition to payers and instead work toward mutually beneficial relationships while still negotiating firmly for what they need. He acknowledged this is harder in markets where a single payer holds significant leverage, but maintained that even in those environments, progress is possible, just slower.

Managing Multiple Lines of Business

Mark Llorente, chief operating officer of InnovaCare Health, described the challenge of being a multi-payer, multi-product provider group operating across Florida and Texas with 25,000 full-risk MA members and approximately 6000 accountable care organizations (ACO) members. He notes the importance of being able to see members as often as their clinical needs dictate. As he put it, “If we can't see you with the frequency we want to see you, then should we be in that line of business? “To ensure this, InnovaCare has built a capacity-based scheduling framework to ensure each line of business receives proportional attention, not just MA. However, he did note that the organization spent the last several years almost exclusively focused on MA performance, and is now intentionally recalibrating to give commercial, Medicaid, and ACO populations their fair share of clinical resources.

Llorente also emphasized the importance of setting clear expectations with members from day 1, particularly in defining the kind of managed, proactive care relationship InnovaCare offers. The organization uses a dyad leadership model, which includes clinical and operational leads closely working in tandem at the local level where they build relationships with the providers and patients. He credited this approach as a meaningful driver of results in markets where the model has been implemented.

Astrana's “Payer-Agnostic” Model

Tyler Tracewski, vice president of value-based programs at Astrana Health, described Astrana as a physician-centric, technology-enabled, risk-bearing organization operating across 16 markets with over 1.6 million members and relationships with more than 20,000 providers. A defining feature of Astrana's approach is its relatively “payer-agnostic” model. In its densest markets, it contracts with virtually every payer across commercial, Medicaid, MA, and original Medicare. This allows Astrana to maintain a longitudinal relationship with the patient through the physician, regardless of which plan the member chooses in any given year.

Tracewski highlighted Astrana's progression along the risk continuum as a key metric. In 2021, none of its revenue came from full-risk arrangements. By 2025, nearly 80% did. From the payer's perspective, he argued that partnering with an organization like Astrana reduces medical loss ratio volatility for individual payers, thus providing more predictable financial outcomes than managing risk in-house.

On data and attribution, Tracewski identified delayed or inaccurate attribution as one of the most damaging operational challenges and downstream impacts. When care teams are working off incorrect member lists, interventions arrive too late to move outcomes, and provider trust erodes quickly. He noted that “as soon as one thing happens that triggers the doctor's lack of confidence... [the] conversation's over and they kind of move on.”

Millennium's Clinical Model Focus

Kevin Spencer, chief medical officer of Millennium Physician Group, brought a primary care–centric perspective. Millennium manages roughly 240,000 patients in full-risk arrangements across Florida, Texas, North Carolina, and Georgia, with approximately half in ACO structures and half across 14 MA plans. Spencer's central argument was that while the payer-provider relationship is foundational, what will ultimately determine success over the next 5 years is what happens inside the exam room. Organizations that can identify high-performing physician panels, study the characteristics that drive strong outcomes, and systematically replicate those behaviors at scale will be the ones that survive CMS' continued pressure on revenue. He pointed to guideline-directed medical therapy as a specific and underutilized lever with data showing that fewer than 20% of patients with relevant diagnoses such as heart failure are on these regimens,¹ despite data showing a 60% reduction in admission rates for those who are.²

He also notes that physicians should collaborate more with payer leadership: “I'm not interacting today with the health plan CMOs in a way that would be most productive—and that needs to start.”

Delegation, Data, and Risk

The session's Q&A reinforced several recurring themes. On delegation, Millette said that capitation and delegation remain misunderstood and underutilized tools and that he wants to see delegation of care management, utilization management, and claims data to access real-time information that allows his teams to act proactively.

On benefit design, attendees raised the issue of payer plans loading supplemental benefits such as grocery cards and gift cards onto plans that providers carry the financial risk for. Both Spencer and Llorente acknowledged the problem while noting that macro market forces are beginning to create pressure toward rationalization and that conversations about sustainability are being had to ensure transparency.

Millette also noted that "risk is an asset." When a provider group gives risk away to payers or large aggregators without understanding its value, it is giving away something real. Providers should enter risk arrangements with clear eyes about what they are transferring and ensure the compensation reflects it.

References

1. Jacobs JA, Ayodele I, Bress AP, et al. Social determinants of health and disparities in guideline-directed medical therapy optimization for heart failure. Circ Heart Fail. 2025;18(1):e012357. doi:10.1161/CIRCHEARTFAILURE.124.012357

2. Baksh G, Haydo M, Frazier S, et al. Improving utilization of guideline-directed medical therapy for heart failure. J Nurse Pract. 2024;20:105108. doi:10.1016/j.nurpra.2024.105108