By Cory Thornton, Senior Editor, OPEN MINDS
The relationship between specialty provider organizations and health plans has changed dramatically over the last 10 years. At present, not-for-profit organizations increasingly rely on their relationships with health plans, accountable care organizations, or specialty benefit management companies, making the ability to obtain and retain contracts with health plans an essential element for success.
As a result of this shift, provider organizations need to invest significantly in marketing to and contracting with health plans. We cover the “how-to’s” to developing successful and sustainable health plan partnerships in our July 2023 Management Newsletter, but here I’d like to focus on six additional tips for helping you manage your health plan relationships:
- Make certain that health plan relationship development is part of your strategy.
- Continue to build your performance culture and capabilities.
- Remember to focus on consumer marketing.
- Make great customer service and satisfaction happen.
- Invest in and leverage the right operations and clinical technologies.
- Commit to evidence-based practices.
#1: Make certain that health plan relationship development is part of your strategy. It’s hard to underestimate the importance of health plan relationships in your strategy development process. Most Americans with insurance have their health benefits managed by some type of health plan. Building and maintaining mutually beneficial partnerships with health plans should be part of your strategic plan. It is essential that your leadership team has a deep understanding of health plans in your market, including their pain points, network and service needs, performance expectations, and preferred contracting models.
#2: Continue to build your performance culture and capabilities. Success with health plans requires a performance culture in your organization predicated on data-driven decision-making and performance improvement. You need an established infrastructure, staffing, and data literacy to manage your organization’s operations, in addition to value-based contracts. To shift to a performance-oriented culture, encourage education, adaptability, change management, and accountability at all levels of the organization. Use data to inform financial and clinical performance improvements. And be prepared to report and guarantee it in your contracts with health plans.
#3: Remember to focus on consumer marketing. Next, anticipate that maximizing the necessary revenue might require a new investment or recommitment to consumer marketing. Executive teams should revisit their approaches to brand development, reputation-building exercises, and web optimization to highlight unique services and reinforce value with consumers as well as health plans.
Here is a quick list of key elements for consumer marketing:
- Offering the right services, with the right positioning, at the right price.
- Invest in “pull-marketing” techniques for payers and referral sources.
- Invest in marketing materials.
- Prioritize web content planning, website design, and search engine optimization.
- Maintain your brand, reputation, and relationships with referral sources and consumers.
- Build customer web functionality that integrates with service delivery.
#4: Make great customer service and satisfaction happen. Often, the path to a happy health plan includes happy consumers, so make exceptional customer service the norm at your organization. To do this, your organization needs to measure and manage consumer experience and engagement. See more about this at Measuring & Improving Consumer Experience, Consumer Engagement & Consumer Performance – A Best Practice Approach. Keep in mind that improving customer satisfaction is more than just the “low hanging fruit” of the consumer experience (e.g., improving wait times, ease of appointment scheduling, or the friendliness of staff). Excluding these consumer service efforts would be a mistake. But, for a truly consumer-centric business model, provider organizations need to re-engineer service lines and operations from referral through discharge in their entirety.
#5: Invest in and leverage the right operations and clinical technologies. Running a value-based reimbursement (VBR)-savvy provider operation means reconfiguring technology to support VBR, including a mastery of tech infrastructure, data analytics, and population health management. Every provider organization might start at a different place (some are more sophisticated with technology than others), but all need to regularly update their investments. There are so many new health care technologies on the market (see Do It Now!). Determine what technologies you need to support your operations, VBR contract models, and health plan expectations, and implement them.
#6: Commit to Evidence-Based Practices (EBP). Clinical expertise and innovation are important for all clinical outcome measures. And standardization of services with evidence-based best practices is essential to maintaining good health plan relationships. The reason is simple. Adopting EBP and standardizing care is best practice, AND health plans expect it!
When it comes to managing your relationships with health plans, performance is the common denominator. After you land the contracts, you must be able to demonstrate that you are providing the very best service.