Increase Quality and Decrease Cost of Care

Carrie Spunar, Director, Marketing Healthcare Consulting

cost of care

The U.S. health care system is consistently challenged to deliver high-quality care at an affordable cost. Even with the best of intentions to improve patient care and outcomes, the health care system has become a complex web of technology, rules, operational processes, performance metrics, and reporting requirements that can be inconsistent and confusing for the health care delivery community.


Health plan performance is dependent on highly functioning physician practices, yet most health plans maintain an “arm’s length” from their practices and lack detailed knowledge of the inner workings of a physician practice. Without a detailed understanding of how physician practices work, health plans can’t provide the support or assistance practices need to succeed under value-based contracting arrangements. Physician practices need to position themselves in the new value-based care market, but they lack the time, focus, and skills to do it alone.


Forward-thinking health plans aiming to outpace their competitors and reap the rewards of value-based arrangements need to establish an approach that will provide hands-on help to physician practices. This requires relatively small yet targeted investments that will help practices modernize their daily operations and streamline care delivery to create a positive return on investment.

As value-based care contracting arrangements continue to expand, health plans and physician practices are becoming increasingly dependent upon each other for survival.

What can be done to bridge the gap?

Medical Advantage has produced results by providing in-practice “coaching” to move the needle on important performance metrics and drive change in the physician office, increasing the quality of care, Stars ratings, and ultimately revenue. Sometimes it can be difficult to know where to begin. By following these five simple steps, you can build a program that will engage physician practices and generate the results you desire:

  1. Set Priorities
    A successful strategy begins with the overall macro-level goals that must be achieved for both the health plans and physician practices to be successful. This strategy is then segmented into smaller, more attainable goals for each practice.
  2. Recognize Diversity and Unique Needs
    While there are many common themes among physician practices as they work through the elements of value-based contracting, there are also unique needs within each practice. An initial assessment of the current state is critical to determine the best approach for each practice.
  3. Build Trusting Relationships
    Establishing trusted relationships with physician practices is an essential step in promoting transformation. Coaches should be introduced as positive change agents, regardless of whether they’re affiliated with the health plan, the value-based program, or an independent consulting organization.
  4. Leverage Technology
    A critical step in creating success in value-based contracting is teaching practices how to fully employ the software and tools they already have and helping them to eliminate redundant or unnecessary technology.
  5. Offer a Robust Toolkit
    Because we know that no two physician practices are alike, and virtually no two health plans are alike, a robust toolkit is needed to start a practice moving forward from where they are today.