Want to speed adoption of new evidence-based care guidelines? Try getting insurers and providers to work together

handshake over a desk with computers and someone taking notes
Payers and providers can team up to accelerate the use of evidence-based care. (Rawpixel)

It takes 17 years on average for a discovery in the lab to make it to the bedside.

But better collaboration between insurers and healthcare providers could help accelerate the use of evidence-based care, according to a new report from the Alliance of Community Health Plans.

“Their shared community roots and deep investments in relationships with local healthcare providers build common ground, stability and longevity—important foundations for establishing trust and effective partnerships,” according to the report.


13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

Where has it worked? Geisinger Health System wanted to address hepatitis C rates and now has a cure rate of about 98% as a result of a collaborative effort between its clinicians and its health plan. The project highlights how payers can change physician behavior by providing the most crucial information—how an adjustment impacts patients, said John Bulger, M.D., the chief medical officer for Geisinger Health Plan.

RELATED: Blue Cross Blue Shield: Total Care program reduced hospitalizations, ED visits

“From a quality of care standpoint, it was a huge win, and from a cost standpoint, it was a huge win,” Bulger said.

SelectHealth, Intermountain Healthcare’s health plan, and Presbyterian Healthcare Services’ health plan had similar experiences. Patricia Richards, SelectHealth’s CEO, said that the system had been able to significantly cut back early labor inductions from about 23% to 3%, but got stuck on the latter figure without reaching their goal of zero early inductions.

So, doctors at the system approached the payer and asked it to stop covering early inductions entirely. SelectHealth agreed, and it took just two payment rejections before more hesitant physicians stopped the practice, leading to fewer babies born in need of intensive care.

Intermountain is now trying a similar approach for unnecessary tonsillectomies and hysterectomies, Richards said.

“This was truly a cultural change and a shift in philosophy,” she said.

RELATED: Presbyterian Healthcare Services launches fellowship to train physicians in population health

Presbyterian’s program, on the other hand, was focused on enhancing access to addiction services. The system found that patients were aware of treatment options for substance abuse disorder but were underdiagnosed, said Dan Duhigg, clinical program medical director for behavioral health, Presbyterian Healthcare Services.

Duhigg said that the health plan eliminated prior authorization requirements for medication-assisted treatment, such as suboxone, and worked on education programs with local community groups.

Educating providers and eliminating unneeded hurdles can drive significant change, Duhigg said.

“That’s our way of changing what is done,” he said.

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