Greetings from sunny California, where today we kicked off The OPEN MINDS Management Best Practices Institute. Throughout the day, I’ve had a lot of interesting conversations with attendees – everything from new strategies for combating the opioid epidemic, to new models for integration with primary care, to new technologies to promote better care coordination. Interestingly, all of these conversations came back to one resounding theme: The importance of building relationships between payers and provider organizations.
In a market filled with change, there are many opportunities for innovation, but the reality is that most of these programs and services are not sustainable in the long-term without a payer partner. Because the traditional roles of provider organizations and health plans are shifting as we move to a more value-based reimbursement market, there are more opportunities for innovative partnership models and gainsharing arrangements with payers (see The Business Model Transition To Value-Based Care).
We discussed this theme in more detail in the session, Finding The New Opportunities With Health Plans: How To Market Your Services To Managed Care, led by Steve Ramsland, Ed.D., Senior Associate, OPEN MINDS and featuring Dawn S. Kingsley, MSHA, Vice President, Payer Contracting & Strategy, Centerstone America. Mr. Ramsland’s one golden rule for success in our current market? Don’t treat health plans like adversaries – treat them like partners.
We’ve discussed the idea of payer and provider organization partnerships before (see What Do You Bring To The Table? and Strategies, Tools & Techniques That Enable Payer‐Provider Collaborations & Partnerships) – but what does this type of “partnership” look like in practice? A partnership needs to be mutually beneficial to both organizations – this means there needs to be some give and take and a genuine interest in working towards the same goals. This requires regular communication; developing relationships with both clinical and network staff; learning about the needs of the health plan in your market, keeping them informed about your organization; and two-way sharing of outcomes, data, and accomplishments.
For an on-the-ground perspective, we heard from Dawn Kingsley at Centerstone, a non-profit behavioral health organization operating in five states with more than 59 open contract discussions with a variety of payers. These contracts run along the full continuum of reimbursement options – from fee-for-service, to case rates, to capitation.
Ms. Kingsley discussed the steps that Centerstone utilizes in building new partnerships with health plans in their markets. The first step is mapping the market and trying to understand the payer’s “pain points.” Ms. Kingsley explained that their team actually completes a SWOT analysis of each payer to drive their marketing decisions. This gives them a picture of what health plans are looking for and how Centerstone can meet their needs.
The second step is actually finding the right person to talk to and developing that initial relationship. The most important part of this step is being persistent. It may take months to cultivate a positive relationship, and it may require some looking for connections through different avenues with different approaches, but generally this persistence will pay off.
Finally, once you make the connection, don’t waste your opportunity. When discussing your organization with the health plan, remember they are not looking only for your organization’s merits, they are looking for a proposal of how your organization can help them to meet their goals. This proposal cannot be one size fits all, it needs to address the specific problems that the health plan is looking to solve. Ms. Kingsley noted that it’s unlikely that an organization will be able to meet all of a payer’s needs, but you should be able to fill a niche for them.
Moving to value-based contracting is a slow process and often times, provider organizations will be operating in both worlds. The key is working with payers to manage both types of contracts and developing relationships with the goal of becoming an exclusive provider organization.
For more on managed care contracting be sure to join us at The 2017 OPEN MINDS Executive Leadership Retreat for the session, “Meta-Leadership In Action: Partnerships With Managed Care,” led by OPEN MINDS Senior Associate, Ken Carr. And, be sure to follow our coverage of The 2017 OPEN MINDS Management Best Practices Institute over the next couple days on Twitter @openmindscircle – #OMBestPractices.