Throughout this week’s 2018 OPEN MINDS Strategy and Innovation Institute in New Orleans, there were several sessions on the “how to” of value-based contracts with health plans: How to develop a service and a rate. How to incorporate telehealth and other technology into the rates. How to optimize performance. How to develop the contractual relationships.
But if I walked away with one piece of advice across many sessions, it was that understanding the “need” of health plans in your market for the consumers you serve is key to success. Provider organization executive teams may be able to come in with a concept – but developing a solution to a specific pain point is the key to contracting success.
I had a chance to listen in on a deep dive on this issue in the session, New Contract Development: Marketing To Payers & Other Stakeholders, featuring William G. Wood, M.D., former National Medical Director, Medical Management, Behavioral Health Division, Government Business Division, with Anthem, Inc. and Steven E. Ramsland, Ed.D., Senior Associate with OPEN MINDS. They offered tips for what provider organizations executives can do to form relationships with health plans with three key steps – identify the ‘pain points’ of health plans, meet frequently with a number of health plan executives, and preserve.
The first step is research on the health plans in your market — and what they need. Dr. Wood explained that the pain points for health plans differ based on whether you are offering an inpatient or outpatient treatment model. For provider organizations offering outpatient treatment, many of the pain points revolve around addiction treatment. Health plans are looking for provider organizations that offer medication-assisted treatment and follow the American Society of Addiction Medicine (ASAM) criteria. They are also looking for organizations that can integrate behavioral health with primary care. Finally, and importantly, they are looking for provider organizations that can offer access to services quickly-either via same-day appointments or walk-in appointments.
On the inpatient side, payers are looking to curb readmission rates and improve follow-up after readmission. They are looking for programs to address these challenges. This includes connecting individuals to primary care, having linkages to outpatient provider organizations post discharge, and trying to improve the connection between inpatient and outpatient provider organizations.
Dr. Ramsland, noted while these are the pain points that provider organizations are experiencing generally, every health plan will be different depending on the market. It’s important to understand who they are, what types of programs they offer, their market share, etc. There are two stages to building relationships with health plans – the initial meeting to get your organization in the door and then continued follow-up to build the relationship.
Meet With The Payers
Once you’ve done your research, its time to meet with the executives of the health plans. Knowing who to contact can be tricky. Dr. Wood suggests trying to talk to both the clinical and provider network development staff – and to develop an outreach strategy to meet with people at a higher level. (Other health plan faculty at the institute suggested that you meet with the head of plan in your state, the director of behavioral health, or the network manager.)
Once you set up the meeting, there are a couple of key talking points to prepare. The first is your ability to provide access to services and the effectiveness of the services you offer. Make sure you don’t focus on all of your service lines. Rather, select a few key areas that have the best outcomes, are the most innovative, or serve a particularly vulnerable population. The second is to talk about any quality management and compliance programs that you have. Other areas of interest for your “presentation” are links to other provider organizations in the community, your focus on treating the whole person, and whether you can treat individuals with a dual diagnosis.
After your initial meetings, don’t expect a “done deal.” It is important to continue to build the relationship in order to develop a contract that looks more like a partnership. Check in with the health plan executives frequently – and keep them updated on any developments with your programs and new performance results. In order to continue to build the relationship, offering to bring together all the health plan managers in your area to propose a specific solution. Dr. Wood said that there really isn’t a downside to bringing them together, and it is a step toward building professional relationships and collaboration.
In the years ahead, with the predictions of more value-based reimbursement, it means that there will be fewer, larger contracts with provider organizations. Provider organization management teams need a contracting strategy — and a long-term vision to make that strategy a reality. For more, check out these OPEN MINDS resources on building relationships with payers:
- New Contract Development: Marketing To Payers & Other Stakeholders
- How To Move From Idea To Action: A Guide To Building Successful Partnerships With Managed Care Organizations
- Finding New Opportunities With Health Plans: How To Market Your Services To Managed Care
- How To Develop A Value Based Reimbursement Agreement: The Centerstone/Passport Health Case Study
- The Health Plan Perspective On Improving Performance & The Future Of Value-Based Contracting
- The Strategic Path To Health System Sustainability: Lessons From Northwell Health
- From Health Plan Contract To Health Plan Partnership In Four Steps
To learn more about moving to value-based reimbursement, join us at The 2018 OPEN MINDS Executive Leadership Retreat for the session, “The New Leadership Challenge: Culture & Change Management In A Value Based Market,” featuring John F. Talbot, Ph.D., Chief Strategy Officer, Jefferson Center for Mental Health, & Advisory Board Member, OPEN MINDS.