Key Players in Health: Patients, Providers, Payers, Vendors

Patients

Patients are the individuals who receive treatment from providers. Most patients have some form of health insurance through their employer or the government, whereas others purchase and pay for insurance themselves. Payers receive a monthly premium from patients (or their employer or the government). Generally, health insurance helps patients cover their medical costs after the deductible is met.

Providers

Providers are the doctors and institutions that provide treatment to patients. They are typically part of provider networks, such as HMOs and PPOs. A majority of all of the money that providers make is received from payers, whereas a minority is received from patients. Providers purchase products and services from vendors to run their business and improve operations.

Payers

Payers are the institutions that pay providers for the treatment that they give to patients. They include health insurance companies and the government. Additionally, payers could also be employers if the employer operates a self-funded health plan. Payers purchase products and services from vendors, usually with the goal of reducing healthcare costs.

Vendors

Vendors are businesses that sell devices, products, services, and software solutions to providers and payers. Popular examples of vendors include Cerner, Cotiviti, Epic, and many more.