What health plan chief medical officers are prioritizing in 2018

By Jasmine DeSilva and Tracy Walsh, MPH

The preliminary results are in! We asked a dozen chief medical officers from health plans across the country what their most pressing strategic challenges were. Most CMOs prioritized understanding the path forward for accelerating provider participation in downside risk payment models. However, there was less agreement in identifying the specific targets most needed to improve the ROI of population health initiatives.

Here are our three main takeaways from the survey findings:

 

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1. "The road to downside risk" ranks as the #1 priority, flagging payment transformation as the top cost-containment strategy for CMOs.

"The road to downside risk" soared to the top as the highest ranked research topic out of the 40 considered. Seventy-three percent of the group assigned it as “immediately valuable and not currently available,” and nearly half of CMOs selected it as a "Top 3 Choice" overall. Regardless of tenure, plan size, and plan type, CMOs are clearly aligned on its importance. They agree that downside risk represents an opportunity to bend the cost curve while maintaining quality of care, but most are still struggling with scaling provider engagement and adoption of the payment models.

2. CMOs know the limits of their own interactions and look for new ways to delegate care management responsibilities to providers.

CMOs showed consistent interest in topics anchored in care management, such as predictive analytics for risk segmentation, best practices in closing care gaps, and tactics for seamless patient transitions between care settings. If CMOs intend to shift more financial accountability directly to providers, health plans will need to arm providers with more effective and efficient population management capabilities.

3. CMOs define their role as a champion and advocate to providers in their network.

The top scoring issues frequently relate to provider partnerships and collaboration – either in integrated care management models, value-based payment, specialty pharmacy, or the promotion of right-site care. This highlights the unique opportunity that CMOs have in fostering more effective relationships with providers to enhance plan performance across many key functions.

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