Insurance payers and healthcare providers rely on each other, with both sides contributing to providing treatment and other services to patients. However, the connections between medical professionals and insurers are often complex and challenging. Doctors often feel that completing mountains of paperwork and complying with practices like prior authorization gets in the way of serving patients.
The rise of value-based care has brought new opportunities to transform this dynamic and achieve better outcomes, but there are serious questions for payers to address. If they can seize chances for collaborating and sharing information, all stakeholders could reap advantages in meeting their goals. Physicians and insurance companies alike stand to gain from improved relationships that make it as simple as possible to deliver quality treatment. Strengthening communication is the first step toward making that shift a reality.
Making authorization and payment easier
“Physicians want insurers to be allies in delivering treatment.”
Physicians want insurers to be allies in delivering treatment, but they often seem to be working at cross purposes. Reporting from the 2017 America’s Health Insurance Plans Institute and Expo, Fierce Healthcare provided some key insights from payers and healthcare professionals into how to improve matters. Attendees outlined several pain points that representatives need to take into account in any effort to enhance communication.
While it’s important for providers to justify costs, especially in a value-based system, obtaining prior authorization for common procedures can seem overly difficult. Finding ways to make this process easier and generally cut down on paperwork are effective means to build better relationships. Further, insurance companies can help doctors by taking an active role in collecting payment from patients on high-deductible plans.
Offering the information that doctors need
Many providers feel they don’t receive as much guidance and support from payers as they would like. In the 2018 Annual Healthcare Professional Communication Report, 734 physicians, nurse practitioners and physician assistants shared their perspectives on engagement with insurance companies and life sciences firms. Among these respondents, 72 percent said they would be interested in hearing more frequently from insurance carriers, PPO networks and Pharmacy Benefits Managers plans.
There are numerous ways that payers can leverage this opening to become closer with doctors and other providers, including passing along more messages on the practical matters that are the foundation of their relationships. Healthcare professionals expressed a particular desire for more information on drug formulary coverage and copay schedules, with more than 48 percent dissatisfied with the current level of communication. Forty-three percent of respondents said they want to receive additional updates on reimbursement fee schedules.
Providers also want patient education materials on insurance reimbursements and drug formulary coverage, with 68 percent saying they would at least occasionally use these items. Doctors get the most out of printed educational literature that they can easily pass along during office visits. However, 80 percent said they would direct patients to industry-sponsored websites for information at least some of the time.
Sharing quality data
Transparency into the information gathered by healthcare organizations is an increasingly important part of care delivery and reimbursement. Value-based care relies on extensive data that allows stakeholders to manage relationships, monitor performance metrics, meet compliance standards and predict the results of new initiatives.
For both payers and medical facilities, setting up robust procedures for gathering, managing and analyzing this quantitative information is an essential step toward smoother engagement efforts and optimal results for patients. Providers and payers can develop a clearer perspective on prevention and treatment by sharing accurate data and planning for the future accordingly. On the other hand, poor quality databases may lead to operational inefficiencies, financial losses and issues in meeting the requirements from the Centers for Medicare and Medicaid Services.
Maximizing the usefulness of findings that could benefit healthcare providers and insurers means weeding out misleading outliers, eliminating duplicate entries and correcting errors. That’s why data cleansing is necessary for any analytics-driven strategy. Drawing on data append and data cleansing services could make the difference in fueling productive, long-term cooperation between insurance companies and medical professionals.
Reliably connecting with physicians
Establishing stronger bonds with healthcare providers requires up-to-date contact information and effective strategies for deploying communications. Forty percent of the medical professionals who answered the Healthlink Dimensions survey said they never check their own listings in online payer directories, and 53 percent had discovered at least minor discrepancies. It’s vital for insurers to have access to a database that includes the latest emails for providers, along with other important information, such as their titles, geographic locations, specialties and affiliations with hospitals or group practices.
The more that payers know about healthcare providers, the more effectively they can target emails, educational materials. Details on a target audience’s treatment history are invaluable for connecting with more doctors, encouraging cooperation and engagement. Payers develop a deep awareness of what conditions doctors routinely manage and the strategies they use most often. With physician network insights, insurance companies can identify new markets and move proactively to acquire more business.
The best way to get in touch with healthcare professionals is via email, according to 73 percent of the respondents from the Healthlink survey. Working off a thorough base of data and extensive analysis, payers can get the best results out of these contacts. Ongoing success in the move toward value-based care will demand forward-looking relationships between doctors and insurance companies, and the right information empowers these connections.