Unique Challenge
The COVID-19 pandemic put our national healthcare delivery system and their staffs to the test, and the Great Resignation compromised our institutional knowledge. New partnership strategies between health plans and healthcare providers are now needed to invest in the recruitment and retention of tomorrow’s workforce and ensure sustainable pathways to care for all members and patients.
Bespoke Approach
Value-based care agreements allow providers and health plans to partner with a focus on healthcare-employee retention. Some ideas for strategic collaborations between health plans and healthcare providers that may begin to address this issue include:
Revisit how quality incentives are structured
Healthcare providers and health plans have partnered for years to develop quality incentive programs that improve outcomes and reinvest in the delivery of care. But many of these programs have an administrative component that taxes the provider’s office, such as completing diagnosis attestation forms.
Realigning the way incentives are structured so they reduce the burden on the provider’s office will help improve their ability to focus on delivering direct care. Provider groups also have an opportunity to reassess how those incentives are shared with staff to align with their retention and improvement initiatives. A shift in incentive sharing not just to provider systems, but down to providers and staff, will help align engagement toward value-based goals and objectives, reward supportive actions and decision making, and recognize the value those front-line staff provide.
Reducing the administrative burden on staff and providers allows them to focus on direct patient care and improves a patient’s experience, outcomes and staff satisfaction.
Align patient engagement activities
Population health outreach and supporting the ways patients navigate the appropriate pathways of care are critical activities to ensure positive patient outcomes. Many provider groups have adopted strategies for outreach, some of which are automated. Similarly, many health plans have invested in member-centric activities to achieve the same outcomes.
Providers and health plans can partner to align their population health and patient navigation strategies, minimize administrative utilization requirements between preferred providers, and improve the overall member-patient experience.
By intentionally aligning efforts to support patients, the risk of redundant work is reduced and leads to improved staff and provider satisfaction and patient experience.
Participate in networks that meet your needs
Healthcare providers who participate in networks that do not have adequate specialists to meet their patients’ needs may experience an increase in their complexity of care, resulting in higher-touch encounters and increased staff fatigue. By identifying your patient population’s needs and partnering with provider networks, healthcare providers can influence provider networks to ensure their patients receive the right care at the right time by the right provider.
Further, choosing to partner with provider networks that reduce or eliminate administrative burdens for in-network patient navigation will decrease the volume of paperwork completed by staff and improve the patient experience.
Participating in health plan networks that are ready and able to collaborate with healthcare providers can result in improved provider and staff experience, reduced administrative burdens, and help ensure patients can access the right care at the right time.
Value Based Payments Pass Throughs
To support the transition from fee-for-service to value-based incentive reimbursement, traditional fee-for-service payments must be shifted through health plan and provider value-based arrangements that provide revenue tied to the achievement of value-based metrics. While these arrangements are often made between a health plan and health system or physician group, the rewards for achieving those metrics should be set up to trickle down to physicians and front-line staff. This will not only facilitate their buy-in, but it will also provide incentive for them to stay and invest with their employers while aligning with patient-centered care goals.
Shifting revenue from sheer volume to conditional value-based payments carries an element of risk for a provider. Sharing this risk is important, so arrangements should be structured with graduated percentages for achieving partial goals and a strict amount of revenue shifted from fee-for-service to value-based payments. In addition, providing proactive upfront payments or high-frequency monthly/quarterly payouts based on progress toward goals helps greatly to moderate the risk of value-based agreements. It not only decreases the risk to revenue constancy, but it can also be used to promote consistent staff engagement through more frequent employee bonuses, employee education, training, and to cover the cost of shifting job functions toward value-based activities, such as population health analysis, care coordination/management and patient education.
Recommended Action
Healthcare Providers: Identify employee retention strategies that ensure a broad diverse approach that is meaningful to your practice and partner with health plans to align incentives with those key initiatives. Additionally, engage health plans in reducing administrative burdens and redundancy in patient outreach. Partnering with plans should result in beneficial relationships to support employee satisfaction and retention.
Health Plans: Reach out to your large and small contracted network providers and be receptive to their needs as they work to ensure a future delivery system to meet your enrollment needs. Work with them to execute value-based arrangements, offer up-front payments to support the transition and partner
Partner with Unify Consulting: The transition to value-based care arrangements requires planning and expertise best supplied by finding an experienced partner that can not only help devise strategy, but can also stand shoulder to shoulder with clients and support the burden of the transition work. A partner should also have experts who bring diverse teams and experience throughout the payor and provider spectrum, so guidance can be supplied to all areas of an organization using both qualitative and quantitative methodologies that are culturally sensitive and appropriate.
Unify Consulting’s Healthcare & Life Sciences team has deep experience establishing and optimizing value-based arrangements and has worked with an expansive range of both large and small client organizations. Unify’s expertise includes:
- Provider & Payer negotiations
- Value-Based Care Program Development
- Fee-for-Service to Fee-for-Value Transition
- Provider Network Optimization
- Data Analysis & Visualization
- Change Management
- Organizational Effectiveness
- Patient and Provider Education
- Care Navigation Tools and Tactics
To learn more about how Unify can help your organization establish an effective value-based care strategy, please reach out to us at brand@unifyconsulting.com.
Visit our Healthcare & Life Sciences page to learn more.
