How do health plans, when looking at a steady stream of service model ideas, evaluate the many opportunities? How do they decide which model looks like a winner, and which one goes in the “thanks for coming” pile? That was the question I asked during a recent conversation with Michael Golinkoff, Ph.D., M.B.A., Senior Vice President, Innovation Advisor, AmeriHealth Caritas. Dr. Golinkoff didn’t mince words:
It begins by determining whether the program identifies a problem where we need a solution. What we are really looking for are provider organizations that have the capabilities to address those priority needs. But I’m not necessarily looking for a ready-made product that we can “plug and play.” I’m looking for a collaborator—an organization that has the right talent and infrastructure to partner with to build a model that works for everyone.
What health plan needs are top of mind for Dr. Golinkoff? First, the health plans are always looking to partner with programs that can address the support needs of Medicaid populations with complex chronic conditions—including opioid addiction, alcohol addiction, and social determinants of health (such as affordable healthy food, housing, utilities, vocational, educational issues, and parenting issues). Assessing the impact of these programs doesn’t always come down to solely analyzing outcomes data. For example, program effectiveness can be shown through demonstrated adherence to treatment within a substance abuse program, or predictive improvements for consumers with comorbid diabetes. Second, program improvement can help to assess value. For example, improvement of scores for external quality measures, like HEDIS and the Centers for Medicare and Medicaid Services (CMS) STARS program (e.g., improved follow-up and preventative care measures) can add value to a program. Finally, one unifying issue touched on both of these priorities: a need for better consumer engagement. Dr. Golinkoff explained:
Overall, we are looking for organizations that can engage people. Not just initial engagement, but an engagement that builds commitment over time. I want to see if organizations can capture someone’s attention, get them to interact, and do so over time. Our organization is focused on helping people with their day-to-day lives. That means we’re interested in organizations that understand the life of Medicaid recipients, and can help them not only to get health care services, but also connect them to the social supports they need.
Improving consumer engagement often means having the right management and clinical teams in place, the right operational infrastructure, and a willingness to be flexible and work in a partnership to find the best solutions for consumers. Additionally, Dr. Golinkoff also emphasized the necessity of data as part of this equation. He noted:
I recognize that a lot of organizations don’t have all the right data or outcomes. But what is more important is their potential. I want to know if they value data and have a plan for analysis when they do have data. I want to know if they have thoughts about how they plan to evaluate their program and how it relates back to my pain points, as well as their own goals. I’ll give a pass on not having the data if they are oriented toward extracting the data from our experience together and have a plan for how to do that in the future.
What advice does Dr. Golinkoff have for a manager of an organization with a great new program about how to present that to AmeriHealth? Focus the specific value of your program, be prepared to demonstrate how it will help to address AmeriHealth’s needs, and be open to new possibilities for partnership. Dr. Golinkoff described what he is looking for when he heads into a meeting with a potential provider organization partner:
The most important thing to remember is to use time wisely and cut to the chase. You have a limited time to meet with a health plan partner and present your solution. If the process goes well, and you come to meet me for an hour, don’t waste that time. It is amazing how often people come in and spend the first 30 minutes of the hour telling me about a problem I already know about. For example, don’t give me beautiful data showing how depression drives medical outcomes. I already know this. Spend most of the time telling me about your solution to the problem, and why it’s different than the other 30 solutions I’ve seen.
Ask about and listen for the pain points, talk about what makes you different, and engage in a discussion what a partnership will look like. When you talk about value-based reimbursement or shared savings, if you start without proof, it’s hard to talk about. I’m not going to put everything at risk for outcomes when we have no idea what we’re going to get. I’m looking for long-term relationships and credibility. The best deals are those fairly valued for everyone.
For more, join Dr. Golinkoff on October 24 at The 2018 OPEN MINDS Technology & Informatics Institute for his keynote session, Building Successful Partnerships with Health Plans: An Insider Guide to Payer Relationships Plenary Address.