Solving a problem is the best path to a long-term partnership with a health plan. That was the advice of Michael Golinkoff, Ph.D., M.B.A., Senior Vice President, Innovation Advisor, AmeriHealth Caritas, in our September interview with him, Solve The Problem, Gain A Partner.
A couple months later, in his keynote address, Building Successful Partnerships With Health Plans: An Insider’s Guide To Payer Relationships, at The 2018 OPEN MINDS Technology & Informatics Institute, Dr. Golinkoff took his advice one step further talking about what enables executives of provider organizations to move to the “next level” in collaborations with health plans. His perspective is that there are three key enablers of developing these new relationships and participating more fully in the emerging value-based market—new reimbursement models, expanded technology platform, and focused use of analytics.
New reimbursement models—Having the ability to participate in a new financial relationship with health plans is key. This means both the ability to accept reimbursement other than the more traditional fee-for-service method and to link that reimbursement to performance and outcomes. To build successful partnerships, provider organization executives need to rethink their approach to engagement with health plans and tailor their approach to focus on the information that health plans want. This means understanding health plan needs and providing solutions with demonstrated outcomes. Provider organizations that can show outcomes will be the ones that receive the most favorable payment arrangements. Dr. Golinkoff noted that provider organizations should stop seeing outcomes as secondary and start seeing them as their primary variable in reimbursement.
For more from OPEN MINDS, see The Path To Long-Term Sustainability and Are Your Financial Systems Ready For Value-Based Reimbursement? Managing Risk, Data Modeling & Financial Projections For VBR Success.
Expanded technology platform—In order to make these new reimbursement models work, provider organization executives need to create models for the rapid evaluation and adoption of new technologies. These models should focus on technology that increases the value of care through cost reductions or performance improvement. And, executives need to think beyond the EHR, to more personal technology such as telehealth, remote monitoring, wearable devices, machine learning, and online communities. Not only may these technologies extend the workforce, but they have the potential to offer new access points for consumers.
For more from OPEN MINDS, see Are You Strategically Interoperable? and Using Virtual Care To Improve Your Value Proposition: Best Practices In Integrating Technology Into Your Community-Based Program.
Focused use of analytics—In the end, being able to navigate changes in reimbursement, technology, and service lines depends on having the right data. Dr. Golinkoff made the point that with advancements in big data and analytics, not only is it possible to manage the system but also it will soon be possible to better individualize services at the consumer level. The key is building a metrics-informed system management platform.
Finally, for new approaches to value-focused collaborations to work, there is the issue of legislation and regulation. Dr. Golinkoff spoke to the lag between where the field is going and the laws that support it, especially when it comes to issues around reimbursement for virtual health care, privacy and security of consumer data, and the use of outcomes-based reimbursement and treatment models. This lag—which is both national and state-specific—will mean that innovation will move at different pace in different markets. But, it will move.
To get a sense of where the market is at in the evolution to new relationships between provider organizations and health plans, check out OPEN MINDS’ recent coverage:
- UnitedHealth Moves Half Of Reimbursement To Value-Based Models
- UPMC Announces Value-Based Care Contract With Boehringer Ingelheim For Jardiance
- Medicare Beneficiaries Have Highest Quality & Lowest Cost In Hawaii, Alaska & Oregon
- CMS Awards 7 Agreements For Performance Measure Development For Medicare’s Quality Payment Program
- Seattle To Impose Housing Performance Target Penalties On Homeless Provider Organizations
- New Medicare Bundled Payment Model Has 1,299 Participating Provider Organizations
- Horizon Blue Cross Blue Shield Of New Jersey Reports 4% Lower Cost For Commercial Members In Value-Based Arrangements
- Oklahoma Medicaid Enters Value-Based Contract With Alkermes For Injectable ARISTADA
- CMS Planning To Fund 8 States To Develop Value-Based Contracts For ‘Integrated Care For Kids’ Model
- UPMC Health Plan Enters Value-Based Contract With Alkermes For VIVITROL®
For even more, join us at The 2019 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 14 for the town hall panel, Health Plan/Provider Data Exchange In Pay-For-Performance: A Town Hall Discussion On Meeting The Connectivity Challenge led by Joseph P. Naughton-Travers, Ed.M., Senior Associate, OPEN MINDS.