Health plans and provider organizations say they want meaningful value-based care (VBC), but even the most ambitious organizations often run into cultural challenges within their partnerships. From distrust over data sharing to different expectations around payment, the reality is VBC partnerships require soft skills as well as hard skills.
We recently sat down with Wes Campbell, Ph.D., an Expert Partner at Advisory Board and a former Chief of Clinical Operations for a large, academic health system. Our conversation focused on how to adjust negotiation tactics to be a better partner and how to support your clinical staff during a VBC transformation.
Q: From your time as an executive leader, you have first-hand experience with payer negotiations. Can you speak to an example of a strong partnership with a payer in the value-based care space?
Wes Campbell: We negotiated a primary care ACO contract with a large commercial payer in our state. In contrast to other payers, this organization offered cash up front for the necessary population health infrastructure. The investment really signaled their intent to us; they wanted their business to go into risk and put up enough resources to support us.
Their investment was one of the main reasons we thought it was important to jump into risk. Most provider organizations don't have the resources to make those kinds of investments. But they offered us $400,000 over three years with a risk corridor. They funded staff and information platforms to help us improve our population health interventions.
Q: What's your experience been like in tough moments between a health plan and provider partners? For example, negotiating new risk-based contracts.
Campbell: In any negotiation process, there are going to be tough moments. It's important for organizations to understand where each party stands and their level of interest in coming to agreement. You need to know your best-case scenario if you can't reach an agreement. If your best alternative is to not do the deal and walk away—then the possibility of a difficult negotiation goes up.
Sometimes the hardest part is the different perspectives. Typically, providers want to talk quality and payers want to talk total cost of care. It's like ships passing each other in the middle of the night. It's challenging for providers to understand the motivations of payers—and then for the payers to understand how difficult it is to operationalize their ideas.
How quickly the sticky points get worked out has a lot to do with personal relationships. Relationships help you talk through the difficult stuff in an impartial way.
Q: Do you have any suggestions for how providers and health plans can create strong initial relationships?
Campbell: Understand neither side is the dark side. Both health plan and provider organizations need to remember each other's mission. Providers serve your members. Payers provide coverage to your patients. Both partners need to recognize that any deal together isn't a zero-sum game. And that if they approach it as zero-sum, they're going to run into challenges when it comes time to renew that contract in the future
Leaders must do their homework before their team heads into a negotiation: What're your shared goals? What do you think your partner needs and wants? Can you both identify pathways where you get something even if it's not everything you want?
Q: I'm curious to learn about your experience managing value-based care changes internally. What are some things leaders should know?
Campbell: When my team adopted a new ACO model with our payer partner, we had to make changes to our workflow, focus, and responsibilities. Operations were thoroughly impacted. You can't have the same number of nurses or administrative staff as you did before for this type of shift.
As leaders, it's our responsibility to create the right structures for new processes and give staff tools to manage the change. If you want a change to be successful—and therefore have better population outcomes—you have to create a structure to support the process. You can't just change the process and tell your staff, "Hey here's a new button in Epic" or "Here's a new form for you to fill out."
Think through: How many people are doing this work? What kind of work do they already do? What tools are they using? Do we need to add new staff members? This type of thinking takes time and can be expensive. But it's really a prerequisite to evolving new processes and getting results.
Q: How should leadership support their physicians during a change? Especially one brought on by a payer-provider partnership.
Campbell: It's a lot easier to work through operational changes if you include clinicians in the agreement process early. I would sit down with the leadership of the primary care enterprise. I'd clue them in: "Here's what the payer is asking us to do, and this is the menu of options." And ask them for feedback: "Is this doable? Is this something you even want to do?"
If you're not asking those questions internally, then it's going to make the process a lot harder because nobody knew it was coming. Your staff know where shortages and excesses are. They understand your organization's weakness. They can help you get ahead of a change and make it effective.
Q: How can leaders articulate a vision that creates staff buy-in?
Campbell: My grandfathers were both Methodist ministers. They always said if you weren't out shaking hands with people and asking them "How can I help you?" you weren't doing your job.
Leaders must articulate the vision of the future state. And it must be different and better than it is today. Whenever you make a change, if you aren't visible or accessible to your team, then it's going to fail. It's easy to stay in your office and answer emails—but it really is all about showing up.
Q: If you had one piece of advice for health plans and providers looking to partner in new ways on value-based care, what would it be?
Campbell: When you're looking for new ways to partner in value-based care, don't assume you know what they want—and be as transparent as you can. Transparency breeds trust. Effective partnerships require trust.