Care Transformation Center Blog

Three ways to become a preferred partner for payers


While traditional criteria such as price, predictability, network, and patient satisfaction are still important to health plans, many have developed frameworks for evaluating provider partners on a broader set of measures.

The good news? Health plans are focused on the same things you're probably already working on, such as strengthening organizational commitment to population health, enhancing network capabilities, and integrating health IT.



Organizational commitment: Walking the talk

Is your health system walking the talk in the transition to population health? That’s what savvy health plans are probing to find out.

One good barometer for assessing cultural commitment is whether stakeholders across the organization communicate a consistent definition for population health. We’ve heard of some health plans and employers who want more than just the executive team’s word on organizational readiness and are seeking out frontline physicians to gauge their awareness of care transformation strategies and objectives.

Beyond consistent messaging on population health priorities, highlighting new leadership teams and executives like the chief transformation officer and investments in infrastructure and pilots are also compelling evidence of the organization’s readiness.



Network capabilities: Not just size, but strength

Physician partners continue to be a strong differentiator in evaluating provider networks, but value-based care doesn’t just require a strong scope, primary care base, and specialist relationships.

Health plans will also evaluate the degree of hospital-physician alignment, how well referrals are retained in-network, and how performance standards are set and maintained across the network.

Beyond physicians, providers should be prepared to demonstrate strong post-acute care relationships, collaboration with community partners, and convenient ambulatory care options that extend the clinical care team’s reach.



Integrated health IT: A plan for data beyond the EMR

All organizations have been focused on EMR adoption for meaningful use, but what matters most is what you do with the data.

Savvy provider organizations can demonstrate how health IT supports frontline care delivery and exchange of information across care settings so health plans know they have a meaningful plan not just for adopting, but optimizing health IT. Providers who can show they know how to use their own clinical data will build confidence among health plan partners for when it comes time to discuss sharing of claims data. 



Start the conversation, not just a negotiation

While you might be doing some—or all of these things—today, how are you proactively communicating these changes to your health plan partners?

If you’re organization is ready to take on value-based contracts, make sure you’re presenting health plans with a compelling value proposition that resonates with their own preferred partner criteria.

The most successful value-based contracts aren’t just won at the negotiation table, but through honest conversations about what each party can bring to the relationship and commitment to shared goals.

Next, Build the Right Population Health Framework

With the right population health framework, leaders can use existing capital and personnel to increase care quality, improve patient outcomes, and lower costs. Find out how you can identify the team, framework, and measures you need to evaluate population health initiatives.

LEARN MORE


You might also be interested in checking out this infographic from our colleagues at the Medical Group Strategy Council on how you could be missing the mark with your approach to EMR strategy.



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Meet the Author

Sara Sanchez
Senior Consultant
Population Health Advisor