Over the past 10 weeks, grocery shopping has been largely restricted to struggling to find a delivery window on Instacart or Peapod. However, one “essential” small business that rose to the challenge was my neighborhood grocer, Paul. He actively observed the discussions on Facebook groups to understand the key needs in our community, adjusted his supply chain accordingly, and proactively reached out to customers to make new offerings. And he continued to keep track of discussions, community purchases and pain points to proactively recommend refills or alternates. This is a small but powerful example of someone who capitalized on insights outside of his usual transactional data to better understand his customers and customize his engagement strategies. Health plans need to apply a similar strategy to improve provider engagement in value-based care (VBC).
In our last blog, we talked about how a one-size-fits-all engagement is both costly and ineffective, as providers’ needs are likely going to vary. This was evident in how the CARES Act initially disbursed emergency funds to hospitals based on Medicare billings without taking into consideration the impact of COVID-19. Similarly, as health plans strategize to revisit value-based care discussions with providers, they need to customize their approach based on provider preferences and capabilities.
While health plans today maintain reams of provider data, that data is predominantly restricted to their own interactions, transactions and claims, and it resides in silos across various teams and systems. Health plans have an opportunity here, just like Paul did, to enrich their provider understanding by taking a more holistic look outside of their usual provider data. Our research has found that only a third of PCPs received the support they desired, but those who did were twice as likely to report feelings of high trust with their health plan. For truly customized engagement, health plans need to go beyond their own data and learn about providers by looking at them holistically across the health plan landscape and create actionable provider insights. It is, however, vital to collect and collate data with a purpose. Here are four key attributes that can serve as food for thought on providers’ VBC preferences and capabilities:
1. Appetite for risk-taking: A provider’s appetite for taking on any risk (downside or upside) is indicative of their interest as well as belief in VBC programs. In order to design the right support programs, it’s vital to understand a provider’s risk appetite—based on current exposure to risk-based contracts—along with how it has evolved. Some providers that already have their own health plans, such as UPMC and Intermountain, are already aware of “risk” while providers that have never engaged in any VBC contracts need more educational support to show how risk-sharing has improved quality and reduced cost of care.
2. Quality of care: As providers start prioritizing patient outcomes over cost reductions, their quality of care improves and they become more likely to succeed in a VBC program. A provider’s overall quality of care should not only be measured as a function of its performance across several measures—such as reduced ER use or reduced readmissions—but also be based on certain leading indicators such as wellness programs, member satisfaction, and the offsite and remote services it has in place. Understanding these leading indicators versus focusing solely on outcomes can help payers identify providers that are on an upward quality-of-care trajectory and provide appropriate support.
3. IT sophistication and data-sharing: A well-integrated data-sharing system helps health plans and providers achieve the “Quadruple Aim.” Providers that have an integrated EHR and EMR system, and can efficiently share data outside the system, make it easier for physicians to find relevant patient data and are more likely to succeed in a VBC program. Holston Medical Group, one of the largest multispecialty medical groups in the Southeast, was able to increase value-based payments by 44% with the help of a health information exchange.
4. Headquarters’ influence on practitioners: A provider’s influence on its practitioners is critical in driving a common objective or message throughout the hospital or health system. For example, the more employed physicians a hospital has, the better it can control clinical volumes and implement new quality protocols and treatment pathways. Similarly, hospitals that rely on joint ventures and partnerships for certain key services are likely to have less influence than those that are self-reliant. Health plans that understand this attribute are more able to engage providers at the right level—practitioner, hospital or health system—to create the necessary impact.
While I have shopped with Paul, my neighborhood grocer, before, his innovation has surely won me over as a loyal customer for the foreseeable future. Health plans should follow a similar strategy. While some will be limited in customization opportunities—owing to factors such as regional dominance and existing relationships—others can leverage the COVID-19 crisis as a chance to reinvent themselves, customizing engagement and supporting providers where it truly matters. Developing customized strategies based on these four attributes is the winning recipe for health plans to achieve their VBC objectives.