Health Plans

Why health plans need a new approach to measuring provider experience

Aug. 2, 2020 | Article | 3-minute read

Why health plans need a new approach to measuring provider experience

Health plans play a critical role in facilitating the shift to value-based care (VBC), and what accelerates that success is delivering a best-in-class provider experience. We’ve found that improving your provider experience requires four key steps.

  1. Envision: Establish organizational objectives. Charting a path to improving provider experience in VBC requires contextualizing a health plan’s unique market situation and its objectives.
  2. Enrich: Learn about the provider and their needs. Existing data and external data sources can broaden a health plan's understanding and better inform decision-making.
  3. Engage: Optimize resource alignment. Converting profiles into actionable segments creates an opportunity for health plans to better tailor engagement strategies with providers.
  4. Evaluate: Assess impact. Evaluating the drivers of experience can better direct future investment and provide ROI.

Even the most progressive, high-performing health plans focus on envisioning but fall short when it comes to enriching, engaging and evaluating. In our previous article, we addressed how health plans should customize engagement with providers based on improved provider insights. Quantifying the impact of provider engagement is key to directing future investments and determining the ROI of your VBC strategies, but there are measurement complications. Here’s where many current approaches by health plans fall short:

  1. A simplistic approach to measurement: Here’s an example: A PCP conducts a comprehensive medication review. While that may be worthwhile data, it’s often activity-driven as opposed to outcome-driven, and it doesn’t dig into or explain a VBC-driven change in behavior. Additionally, the checklist style of the review doesn’t provide an opportunity for comprehensive analysis.
  2. Potential bias in scoring provider experience: Even when scoring measures are closely linked to practice transformation, it’s the practice consultants doing the scoring. While this is an acceptable approach, it could create bias. Let’s say the practice consultant finds that the practice has scored 75% on the aspects of the practice she is there to improve. Since this puts the consultant in a tricky spot and may not reflect well on her, she may be influenced by confirmation bias, affecting the results.
  3. Provider experience seen as a byproduct, not a goal: For instance, health plans that create provider councils often retain council members by asking for input from them about who had the best performance or greatest volume over the past year. However, since the providers’ experience is skewed by their participation, this creates a selection bias. Instead of looking at provider experience as a byproduct of good performance, health plans should be looking at how experience drives provider performance.  

By understanding where certain approaches to measurement fall short and integrating the four “Es” into your approach, you’ll work toward accelerating the transition to VBC and be able to measure real impact.


Want to learn more about provider engagement and realizing the value in VBC? Listen to our AHIP Institute presentation with speakers from ZS, Notable Health and the American College of Physicians.

About the author(s)