The relationship between specialty provider organizations and health plans has changed dramatically during the last 10 years as a result of the many shifts in the health and human services market that are adding competitive pressure across the spectrum. In response, provider organization executive teams are forging new, and in some cases “preferred” relationships with health plans.
This means two things: Provider organizations need to upgrade their health plan marketing approach (see Health Plan Business Development For The Entrepreneurial Provider Organization—Step-By-Step), and they need to recognize that landing the contract is just the first step. Successfully managing value-based reimbursement (VBR) contracts and the health plan relationship is equally important. The OPEN MINDS team designed a seven-part checklist for health plan relationship management:
- Make relationship development part of your strategy
- Build a performance culture
- Focus on consumer marketing
- Embrace great customer service
- Invest (and re-invest) in performance measures
- Invest (and re-invest) in technology
- Commit to evidence-based practices (EBP)
Make relationship development part of your strategy—It’s hard to underestimate the importance of “pull” versus “push” marketing on the new provider/health plan relationships to ensure payers know about your unique services. Building and maintaining trust helps create a mutually beneficial partnership and should be part of your strategic plan. Create opportunities for formal touch points (scorecard reviews) and informal touch points (meeting with health plan representatives) that reinforce the value of the relationship (see Health Plan Relationship Building Skills Key To VBR Success).
Build a performance culture—When it comes to building positive and mutually beneficial relationships with health plans, providers have to move past the love/hate relationship with health plans and embrace them as part of the team. To shift to a performance-oriented culture, encourage education, adaptability, change management, and accountability at all levels of the organization. A reliance on metrics will lead to investment in staff performance reviews that use key performance indicators (see Challenges In Changing To A Culture Of Value (Or Making Any Culture Change), which helps create a balanced and unbiased playing field for discussions internally and with stakeholders.
Focus on consumer marketing—Once you strike a deal with health plans and begin to provide services for their members, maximizing the necessary revenue might take a new investment or a re-commitment to consumer marketing. Executive teams should revisit their approaches to brand development, reputation-building exercises, and web optimization to highlight unique services and reinforce value with consumers as well as health plans (see The “M” Word In Health & Human Services Strategy—Why Marketing Should Be Part Of The Everyday Conversation). Here is a quick list of key elements for consumer marketing:
- Offering the right services, with the right positioning, at the right price
- Invest in “pull-marketing” techniques for payers and referral sources
- Invest in marketing materials (print and online)
- Prioritize web content planning, website design, and web search optimization
- Maintain brand, reputation, and relationship with referral sources and consumers
- Build customer web functionality that integrates with service delivery
Embrace great customer service—Often the path to a happy health plan includes happy consumers. Consumer experience and engagement should be part of your strategy (see Customer Experience Is An Essential Part Of Health Care Service). Consider the effect of an unhappy consumer on the STARS ratings from the Centers for Medicare & Medicaid Services and HEDIS scores. The key is to promote a consistent consumer experience with workflows designed for that purpose (see Consumers Know What They Need. Do We?).
Invest (and re-invest) in performance measures—The way provider organizations measure value differs by contract and must reflect data deemed by the payers to have the greatest influence on outcomes and cost. This might seem like a “cut-and-dry” investment, but considering the different measurement sets that can change annually for payers (public and private), it’s a huge investment of time and energy that should be highlighted during meetings. Executive teams need to monitor expectations closely and have a system for making necessary changes (see Are You Ready For Whole-Person Care? Know The Performance Measures That Matter).
Invest (and re-invest) in technology—Running a VBR-savvy provider operation means re-configuring technology to support VBR and mastering those tools and skills, including tech infrastructure, data analytics, and population health management. Every provider organization might start at a different place (some are more sophisticated with technology than others), but all need to regularly update their investments (see Do It Now!). This will keep you at the forefront of data analysis and provide insight into your consumer populations and ways to prioritize interventions (see How To Build Your Tech Infrastructure For Value-Based Reimbursement). Ask yourself these questions to assess next steps with your technology:
- Does it create valuable efficiencies?
- Does it track outcomes and aid documentation?
- Does it promote accurate reporting?
- Does it support clinical best practices?
- Does it support your health plan partnership?
Commit to EBP—Clinical expertise and innovation is important for all clinical outcome measures, and standardization of services with evidence-based best practices is essential to maintaining good health plan relationships. The reason is simple. Adopting EBP and standardizing care allows organizations to control quality through successful repetition of services, which influences staff adoption of acceptance criteria (see Making EBP Adoption Happen).
When it comes to managing your relationships with health plans, performance is the common denominator. After you land the contracts and deliver the services, you must be able to demonstrate that you are providing the very best service to both the consumers and your payer partner.
For more on health plan relationships, check out these resources from The OPEN MINDS Industry Library:
- Navigating The Changing Relationships Between Health Plans & Provider Organizations
- HealthPlan Relationship Building Skills Key To VBR Success
- Building Successful Partnerships With HealthPlans: An Insider’s Guide To Payer Relationships
- What Are HealthPlans Actually Doing?
- Making VBR A Success: What HealthPlans Can Do
- HealthPlan Business Development For The Entrepreneurial Provider Organization—Step-By-Step
- Using Your Performance Metrics To Build A Value Proposition For HealthPlans
- Defining ‘Value’ Is Key To Provider/HealthPlan Conversations
- Five Keys To ‘Partnering’ With HealthPlans On Social Determinants
- How To Build Value-Based Payer Partnerships: An OPEN MINDS Reading Book On Best Practices In Marketing, Negotiating, & Contracting With HealthPlans