U.S. healthcare has been through many changes over recent years, but the movement toward value-based care has now been firmly established as a major force influencing the futures of practices and hospitals. The Centers for Medicare and Medicaid Services have proceeded with instituting programs that offer higher payments based on quality of treatment and discouraging facilities from excessive readmissions. Other payers are following suit with their own reimbursement rates, and a survey conducted by the American Medical Group Association showed that value-based initiatives have become a primary factor influencing executive compensation incentives.
Making the adjustment away from fee-for-service models and embracing value-based care still presents challenges for many hospitals and medical professionals. One of the most important steps that payers can take to smooth this transition is placing a renewed focus on engaging and communicating with physicians. Closer partnerships between providers and payers are crucial to achieving the potential of value-based programs and consistently delivering better diagnostic, treatment and preventive services to patients.
How payers and providers are working together
“When value-based efforts are successful, there are measurable benefits.”
When value-based efforts are successful, there are measurable benefits for medical facilities, patients and insurance providers. The Blue Cross Blue Shield Association announced that its Blue Distinction Total Care Program, the largest network of value-based care programs in the nation, outperformed other initiatives in nearly all metrics for quality of care and cost. Some of the most noteworthy accomplishments included a 10 percent reduction in emergency department visits, a 5 percent improvement in treatment adherence among cardiovascular patients and a 15 percent drop in hospitalizations.
Aetna’s 2018 report on current trends in health care predicted that value-based models will account for 59 percent of healthcare payments by 2020. The insurer noted the potential impact from important shifts in treatment like increasing personalization and the use of wearable devices to track the progress of conditions over time. However, the report cited growing collaboration between payers and providers as one of the most significant drivers of value-based care in the months and years ahead.
Partnerships between hospital systems and insurance companies can enable a wiser allocation of resources and more efficient spending. In these arrangements, payers and providers agree on key metrics and share accountability for reaching them. They cooperate on enhancing patient engagement, collecting useful data and creating initiatives that bring about improved long-term results.
Driving better outcomes in value-based care
One of the biggest obstacles to productive cooperation between payers and providers is that many physicians have not yet been convinced of the efficacy of a value-based approach. In the State of Value-Based Care survey conducted by Healthlink Dimensions, over 61 percent of medical professionals had either negative or indifferent feelings toward value-based reimbursement. To make payer-provider partnerships successful, more doctors need to be committed to initiatives for improving results while reducing costs and eliminating inefficiency.
More healthcare providers might be supportive of these efforts if they felt actively involved in them. Only about 10 percent of survey respondents said they were very engaged by payers as partners in their attempts to make improvements, and 81 percent said they had no input at all into establishing contract terms. Half stated that they don’t have the tools to run analytics that would enable them to work on data-driven initiatives.
Only one in five respondents said that current conversations about quality standards had very much effect on how they work directly with patients. Still, these medical professionals do have thoughts on how payers can contribute to outcomes, such as changes to reimbursement rates, more efficient filing processes and effective care coordination. The survey answers emphasized the advantages that could come from equipping care coordination teams with additional outside support and data that allows them to streamline treatment and share valuable insights into patients’ situations.
Despite these possibilities, numerous doctors still feel disconnected from value-based initiatives and may think that insurers are not hearing their preferences or addressing their concerns. To optimize the results from new initiatives and programs, payers need to strengthen these relationships.
The importance of reliable communication
More productive connections between doctors and payers start with open lines of communication. Insurance companies can make the first move by reaching out through email, which most healthcare providers prefer as a channel for receiving industry news and updates. Unfortunately, that outreach may run into a dead end immediately if payers are relying on outdated information.
Medical professionals commonly change their emails every time they move between practices or facilities, and many don’t take the time to verify whether their information is updated in payer directories. In the Healthlink survey, 54 percent of respondents said they never checked their listings, and 38 percent had only looked at some of them. That makes it vital for payers to have a database that includes current email addresses, institutional affiliations and other essential details for getting in touch.
Payers can show their genuine interest in forming relationships by segmenting messages and educational materials to make each conversation as relevant and engaging as possible. Using insights taken from past claims, insurers can pick out high-value providers within particular diagnostic classes and send out emails tailored to their needs. Taking into account factors like the demographics a doctor serves and what conditions he or she routinely treats can lead to more appealing messaging that includes useful information.
Providers may benefit from a wide range of support that insurance companies can provide, such as developing a library of patient outreach and educational materials, passing along robust data to back up in-house analytics operations and offering hands-on assistance in organizing care coordination services. In the long run, establishing these mutually beneficial connections with doctors could mean making forward bounds for value-based care strategies and bolstering the clinical results for patient populations. Strategic communications that are targeted toward the right professionals could be the foundation for more open collaboration between payers and providers that streamlines essential processes and proves rewarding for all stakeholders.
Discover physician perspectives on value-based care and more in The State of Value-Based Care Report: Improving Payer-Provider Communication.