As health plans have a larger “footprint” in the U.S. health care system – across all payers covering more types of consumers and more services – doing “business” with health plans becomes increasingly important to the strategies of provider organizations (see Planning For The New Managed Care, How Many Foster Care Children Are Enrolled In Medicaid Managed Care?, and Which States Provide Medicaid Long-Term Services & Supports Through Managed Care?). But how to go from concept to contract?
I thought Carole Matyas, Vice President of Behavioral Health Operations for Wellcare Health Plans, laid out the strategy blueprint in her keynote presentation, The Health Plan Perspective On Improving Performance & The Future Of Value-Based Contracting, at the 2016 OPEN MINDS Performance Management Institute. For the past two years, Wellcare has been moving from a behavioral health carve-out model to a model integrating behavioral health services into the Wellcare network. She was very clear about what Wellcare is looking for – community-based care with a great consumer experience whether delivered by a mental health organization, primary care, a health center, or a hospital. She said:
Health plans are really moving to value-based purchasing. We want to improve the member care experience through a more efficient system with more integrated community-based care. Lots of places are trying to do this, and health plans will buy this wherever they can get it. The move needs to be away from a reactive system, and move to a proactive system. Stop thinking about the poor provider – if you focus only on how the member is doing, you will get more work from us. The more you pay attention to their environmental needs, the more work you will get. And it goes both ways – a health plan can help you understand your population, and the collaborative process can really get you the information you need.
But how to get that “preferred” contract with a health plan like Wellcare? Ms. Matyas offered her five tips for executives of provider organizations looking to create preferred relationships with health plans:
- Show collaborative behavior – Communicate with the other professionals and provider organizations that are also providing services for your consumers. Health plans are looking for ways to better coordinate care and create an improved experience for their members, and the provider organizations that can be instrumental in making this happen.
- Educate your medical colleagues and allow them to educate you – Health plans are quickly moving towards more integrated care strategies, from health homes and medical homes for care coordination to co-located primary and behavioral health care. Be open to this type of collaboration and be willing to work with all professionals to find the best solutions for your consumers.
- Be willing to share new ideas – Remember, most health plans are fairly new at value-based contracting as well. Demonstrate that your organization is also working towards new solutions and is open to discussing the options with your health plan partners.
- Share your data – Show health plan managers what you’re measuring to drive performance and data-based decisions within your organization. Even if they aren’t asking for it, being proactive demonstrates that you are prepared for a value-based relationship.
- Volunteer to pilot programs – In this market, big changes all at once may be too much, so be willing to help health plans try new ideas and test new programs. Becoming part of the experimentation phase will help to position your organization to be part of long-term solutions.
At the close of her keynote, one of the audience members asked a direct question, “So how do you get started? Who do you talk to at a health plan if you have good idea?” Ms. Matyas’ answer is good marketing advice for all provider organizations who are interested in new relationships with health plans. She said that provider organizations’ business development staff should first do some homework – and figure out the specific health plans in their market with the largest enrollment. Start with the provider network manager for those health plans. But be sure to come “armed” with a package that outlines your program models, how they “fit” in collaborative care models, and, most importantly, the consumer data (satisfaction, experience, outcomes, etc.) for those services. And keep working your way “up” the health plan management with your information. Use the interactions that you have with health plan managers to create “custom solutions” and create proposals for pilot programs.
I thought her answer was “business development 101” – an increasingly important skill set for provider organizations. For more on that, check out these resources from the OPEN MINDS Industry Library:
- Marketing To Managed Care: Issues In Providing Mental Health Services For Commercial Insurance & Managed Care Plan
- Creating Partnerships In Managed Care
- Managed Care & The Dual Eligible Population
- The Business Model Transition To Value-Based Care
- Is Your Culture Performance-Driven? Take The Test
And for even more, make sure to join us in New Orleans on June 8 for the session, How To Move From Idea To Action: A Guide To Building Successful Partnerships With Managed Care Organizations, at the 2016 OPEN MINDS Strategy & Innovation Institute.