Physician Partnership: What Practices Really Need from Health Plans

Beth Hickerson, Healthcare Transformation Consultant Health Plan Solutions

health plans physician partnership

The relationship between physician practices and health plans is complicated. Each party has its own priorities and agendas to remain financially viable, and sometimes those priorities conflict. Yet health plans and physicians are inherently dependent on each other for survival, especially with the continuing evolution of value-based reimbursement.

At the heart of any good partnership is effective communication. Unfortunately, there seems to be a communication chasm between health plans and practices. Both sides are acutely aware of what they want and need from the other, but neither side is able to clearly articulate those needs. In an effort to bridge that chasm, here is my advice to health plans, from the perspective of a physician practice.

Provide incentives, both financial and motivational.

It should be obvious that physician practices need some sort of financial incentive to prioritize the pro-active, non-urgent, often non-reimbursable tasks of value-based care over the reactive, urgent, and billable tasks of individual patient care. Expecting practices to participate in value-based care programs solely because “it’s the right thing to do for patients” ignores the reality that life in physician offices is resource-limited. There are always more tasks to do each day than there are hours to do them. Practices must prioritize their time and energy, and economically speaking, it only makes sense that they will prioritize areas that create or protect reimbursement. Make sure that your health plan is offering your physician partners sufficient incentives to engage with you.

Economics are not the only factor at play. Humans are fundamentally emotion-driven beings. Economic incentives will only take you so far without providing sufficient mental and emotional motivation. Physicians and their staff need to see the connection between the administrative actions of value-based care and improved health and quality of life for patients. Connect the dots between the data entered into a web-based application and better outcomes for individual patients.

Personally, my view of population health (a fundamental aspect of value-based care) changed dramatically when I heard a patient give testimony about how her life was saved because the medical assistant at her PCP’s office was persistent about scheduling an annual physical for the patient. That annual wellness check revealed abnormalities that eventually led to early diagnosis and successful treatment of non-Hodgkin’s lymphoma. I suspect that the medical assistant at that office was motivated by the rewards of a value-based care arrangement with a payer, rather than a burning suspicion that the patient had an undiagnosed condition. The result for the patient, however, was the same – early detection that improved odds of survival.

Make it as easy as possible for practices to participate in your programs.

As a practice coach, there was a line in Medical Advantage Group’s recent whitepaper, “Accelerate Success in Value-Based Health Care” that stood out for me.

"The burden of getting credit for all the work physicians do to evaluate, assess, monitor, treat, and prevent suboptimal outcomes has been placed largely on the physician practice. Thus, the seemingly small requests from health plans of their providers are impossible demands from the perspective of a physician practice."

I've seen this time and again in practices. They receive thick packets of “actionable” reports on gaps in care from health plans with meager instructions, or worse, many pages of instructions, on how to use the reports. Deciphering the reports is a feat of concentration, let alone the actual work of closing gaps or supplying the missing data. Health plans send an avalanche of information to help practices comply, but these instructions are anything but helpful for an already overwhelmed practice.

If you need a physician practice to do something for you, follow these three simple guidelines:

  1. Provide information in easy to digest forms. Avoid lengthy pages of dense text. Use screenshots to illustrate required steps. Consider creating short videos of 5-10 minutes in length that walk through report interpretation and needed action steps. Hold live webinars where practices can ask questions.
  2. Gear education toward the people who will actually be using the tools. Often, health plans get stuck in the trap of preparing all communications as if they will be read by the physician, but physicians are almost never your audience for these efforts. Write and present materials for office managers, clinical staff and billing staff. These team members tend to be more connection-driven and less formal, thus they respond better to a more personal approach.
  3. Provide each practice with a direct contact person for questions and issues. The prospect of calling a 1-800 number to ask questions to an anonymous customer service representative will always be more daunting than picking up a phone to call Mary at her direct phone number. Similarly, office staff are much more likely to read and respond to a request that comes from a person they recognize, as opposed to a mass email blast.

If you are already following the guidelines above and your practice partners are still not engaged, try some techniques from the patient and family engagement movement. Seek to understand what is important to your practices. Ask them what you could be doing to make their lives easier. Seek practice input when you are designing new initiatives or communication tools. In short, treat your practices as true partners in collaboration.