Teaming with Providers: Together, Everyone Achieves More
When a team works well together, the members collectively accomplish more than any of the individuals could have accomplished alone. Certainly, we have proven that adage true in healthcare, as can be seen with the success of integrated delivery systems, Independent Practice Associations (IPAs), and Accountable Care Organizations (ACOs).
As health plans continue adapting to the growing influence of clinical quality on its provider network operations, building an effective team with your providers has never been more important.
But, factor in the necessities of compensating members of the team for their role, of each team meeting its profit targets and the competing priorities faced by often short-staffed teams, it should come as no surprise many health plan staff and providers are left wondering how to make it happen. Below are our top five ways to engage your providers to influence your Star Ratings.
- Prioritization: Ensure Clinical, Risk Adjustment, Stars, Claims, and Network Operations are all collaborating and prioritizing their “asks” of the providers and working together to ensure the needs of the providers are met.
- Education, Education, Education: By arming your leaders with the education necessary to purchase the best reporting tools, they are able to develop the goals and framework necessary for the frontline staff to educate and respond to providers.
- Support ICD-10 readiness: If CMS predictions hold true, denial rates and outstanding receivables are likely to increase during the conversion. Despite testing and readiness efforts, it’s entirely possible some providers may not be staffed or prepared to mitigate technology-related problems among its payers or to weather the longer-term reduced productivity of their coding staff. Before your providers can invest additional energy into our Quality priorities, they’ve got to keep the cash flowing.
- Focus on actionability: Health plans often provide catalogs of reports each month showing providers’ numerous views of their panels and forget providers are taught evidence-based medicine and how to care for patients, not administrative functions. By telling providers to improve care, we can make them vulnerable and defensive. By collaborating to improve processes and coordination for better patient satisfaction and outcomes, we can let the providers be providers.
- Continuous measurement, re-evaluation, and reward: While we naturally monitor our outcomes and re-evaluate our processes, we sometimes forget to reward ourselves for a job well done. We can build in contractual provider incentives, but peer recognition and a “thank you” are often simple but overlooked motivators.
Questions to ask:
- Were there any surprises in your first Star Ratings Plan Preview rates?
- Are your providers effectively supporting your Star Ratings goals?
From identifying the health plan functions that require provider engagement, to interpreting Plan Preview rates and trends in order to build 4th quarter Star Ratings action plans and evaluating provider contracting strategies around a holistic approach, our team can help. Contact me directly at emartin@ghgadvisors.com .
Resources
CMS recently notified plans of the first preview period for the 2016 initial Star Ratings data. It is critical for plans to begin evaluating their Star Ratings now to pinpoint problem areas, implement tactical actions, and identify improvement opportunities to raise their current score. Need assistance with your action plan or preparing for plan year 2016? Contact us today >>
At Gorman Health Group, we can help you decide what payment models are appropriate to your unique circumstance and support your implementation efforts. Learn more >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>