The recent enactment of the Patient Protection and Affordable Care Act served as a call to action for health plans to tackle the tremendous cost pressures facing healthcare (which are not directly addressed by the legislation) and to take on the structural components of our care delivery and compensation systems that sustain systematic inefficiencies. At the core of this is health plans' efforts to address the lack of alignment between fee-for-service medicine and the significant waste created by rewarding providers for the "volume of care" rather than for the "value of care."
An example of this effort is the introduction of new payment models that reward care coordination across providers (as reflected by the rapid adoption of patient-centered medical homes) and tie financial performance to keeping patient populations healthy and avoiding unnecessary care. Following CMS' lead, health plans are also bringing forward contracts that will hold hospitals accountable for readmissions and adverse events, with providers expected to bear this risk.
While risk-based contracting holds promise, payors, hospitals and physicians will need to work hand-in-hand to be successful. The current methods of communication (mail, fax and portals) are largely ineffective, and not enough to facilitate the alignment necessary to provide efficient healthcare, especially in the wake of reform. A key element for aligning stakeholders will be determining the support structures (information exchange, communication protocols, etc.) necessary for hospitals and physicians to navigate these new payment models.
But, what support systems should organizations invest in for the greatest impact? Significant investments have already been made on systems that track and analyze results. With CMS incenting the use of standard performance measures (e.g., Star Ratings, accountable care organization measures), analytic vendors have been quick to integrate provider performance measurement into their decision support and reporting platforms. However, performance measures such as "report cards" will not be enough to create the behavioral changes necessary to impact physician performance on an ongoing basis.
Effective communication with physicians is the last mile for health plans, hospitals and ACOs hoping to successfully transition from fee-for-service care. To make this leap, they will need to put a strong focus on transforming their physician relationship management. At the forefront of this effort are new social technologies that are creating more effective ways to disseminate information and communicate with physicians on their terms. With the right physician relationship management structure in place, health plans and health systems can build real, meaningful relationships with physicians that, over time, lead to improved quality of care and decreased costs.
6 Tips to Engage, Retain and Recruit Physicians
An example of this effort is the introduction of new payment models that reward care coordination across providers (as reflected by the rapid adoption of patient-centered medical homes) and tie financial performance to keeping patient populations healthy and avoiding unnecessary care. Following CMS' lead, health plans are also bringing forward contracts that will hold hospitals accountable for readmissions and adverse events, with providers expected to bear this risk.
While risk-based contracting holds promise, payors, hospitals and physicians will need to work hand-in-hand to be successful. The current methods of communication (mail, fax and portals) are largely ineffective, and not enough to facilitate the alignment necessary to provide efficient healthcare, especially in the wake of reform. A key element for aligning stakeholders will be determining the support structures (information exchange, communication protocols, etc.) necessary for hospitals and physicians to navigate these new payment models.
But, what support systems should organizations invest in for the greatest impact? Significant investments have already been made on systems that track and analyze results. With CMS incenting the use of standard performance measures (e.g., Star Ratings, accountable care organization measures), analytic vendors have been quick to integrate provider performance measurement into their decision support and reporting platforms. However, performance measures such as "report cards" will not be enough to create the behavioral changes necessary to impact physician performance on an ongoing basis.
Effective communication with physicians is the last mile for health plans, hospitals and ACOs hoping to successfully transition from fee-for-service care. To make this leap, they will need to put a strong focus on transforming their physician relationship management. At the forefront of this effort are new social technologies that are creating more effective ways to disseminate information and communicate with physicians on their terms. With the right physician relationship management structure in place, health plans and health systems can build real, meaningful relationships with physicians that, over time, lead to improved quality of care and decreased costs.
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Leading Physician Engagement: Spanning Boundaries, Communicating Change6 Tips to Engage, Retain and Recruit Physicians