Employer-provider partnerships need better alignment to curb healthcare costs, industry leaders say

Direct partnerships between providers and employers have a clear opportunity to deliver comprehensive and cost-effective employee care, representatives from both camps said Thursday at the World Health Care Congress 2021 virtual event.

Reaching that point, however, requires clear communication between the two parties so they may reach a shared understanding of the quality metrics, financial incentives and service offerings that will benefit their partnership over the long run.

“We’re on the same team,” Andrea Cockrell, administrative services manager for the City of Plano and president of the Texas Business Group on Health, said during the keynote discussion. “We are aligned in what we’re trying to do for our members and your patients, and I think we can make it better for all parties if we partner and we work together to add value to the community, the members and the patients."

Cockrell said her perspective comes from more than a decade of partnerships with local physician groups. In that time, she said her organization has been able to keep its costs low and introduce just a single increase to employees’ premiums—along with added bonuses of greater primary care engagement and general employee satisfaction.

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Stephen Parodi, M.D., executive vice president of The Permanente Federation, associate executive director for the Permanente Medical Group and chairman of the board for the Council of Accountable Physician Practices, said the California-based healthcare provider has seen similar outcomes across its numerous arrangements with purchasers.

Much of the success can be attributed to similar priorities across both sides of the aisle, he explained. At the top of that list is a shared desire to improve whole-person care via a lasting provider-patient relationship.

“The fact of the matter is, we saw an opportunity [as] physicians who really are providing longitudinal care,” he said. “When a patient joins a practice, we’re forming a … multiyear relationship—and, in the case of primary care, multigenerational. Really, employers have the same kind of approach here. … Most employees join, and the hope is they’re going to be in it for the long haul.”

Cockrell agreed, noting that she and other employers will gladly make higher payments in exchange for strong physician relationships and lower long-term costs. Additionally, she noted many employers would jump at the chance to offload the wellness portals, biometrics screens and similar tools that rarely deliver the same value as a provider who can monitor long-term trends and coordinate additional services like mental health counseling.

The challenge with pursuing and maintaining these partnerships is ensuring both parties are speaking the same language, executives said.

In his organization’s experience, Parodi said employers are used to hearing about quality metrics as translated by a broker and as a result “are largely blind” to what a provider will use to measure care.

“We may be looking at net promoter scores or we may be looking at member patient satisfaction scores—that’s not necessarily what the employer is looking at,” he said. “The employer is looking at ‘I got three complaints from employees in the last couple of days because they couldn’t get in to see somebody because the hours weren’t [right].’ That’s not on a member-patient satisfaction score, and being able to tease that out has been really important, from my perspective.”

Cockrell affirmed that most employers are working in the dark when it comes to understanding “where those buckets of money are really going.”

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Maintaining open and transparent communication can help purchasers understand the value of their provider partner’s services and, occasionally, reveal opportunities for the two to collaborate on promoting healthy practices among employees. These can range from employer-led health messaging to on-site care delivery programs.

“We reached out to [our provider partner] during COVID and said ‘Can you guys assist us in doing some training via Zoom on different mental and behavioral health topics?’” Cockrell said. “If we did not have that kind of dialogue where we were talking directly, that’s something that never would have occurred. That was pretty neat, and another reason why you would want to partner with providers and speak to them directly.”

The conversations between providers and purchasers should also extend to affordability and access, Parodi said. Many of the most impactful conversations Kaiser had with purchasers across its markets during the last 18 months revolved around avoiding payment structures that could potentially disincentivize primary and behavioral care utilization among employees.

“It isn’t hard to build a consensus on what good care looks like,” he said. “What’s the hardest thing is to help people pay for high-value care and mitigate low-value care—and a lot of times, our incentives just aren’t aligned in our typical fee-for-service medicine.”

Beyond their individual business arrangements, there are plenty of opportunities for employers and providers to band together and tackle national-level issues that would be in both groups’ best interests, Parodi said.

"Right now, there’s an opportunity for employers and physician groups to partner around making some of the telehealth waivers that made so much of the care possible during this pandemic permanent,” he said.

“We should actually be speaking as one voice on those because … if the government payer plans will pay for parity, then [health plans] follow suit with employer-purchased plans as well. I think we have an opportunity here [for provider and employer alignment] that wasn’t available pre-pandemic.”