Editor's note: This is the second in a three-part series. The first article explored how payers and providers collaborate to lower costs and improve member experience and care. This story focuses on how payers can better work with physicians and alternative care providers. Part three will discuss technology, including collaborative data-sharing to improve outcomes.
FierceHealthcare invited more than 20 payer and provider executives to dinner to talk about one of the biggest trends in healthcare today: collaboration. In the free-ranging discussion, they offered advice and strategies to help health insurance companies build better relationships with doctors.
It starts with recognizing physicians’ biggest pain point: The increasing weariness they feel over taking time away from their patients to fill out paperwork, dig through data and perform other administrative tasks to meet the obligations of their payer contracts and get paid for their work.
To encourage our guests to speak freely, we aren't publishing their names or the names of their organizations. But the comments below come directly from the CEOs, chief information officers, chief medical officers and other payer and provider leaders who attended the event.
The gathering took place last month in Austin, Texas, during the annual meeting of America's Health Insurance Plans. FierceHealthcare Editor-in-Chief Gienna Shaw led the discussion.
Here's their advice for how insurers can make it easier for physicians to get paid, improve their workflow and also some thoughts on working with alternative care providers.
Make authorization easier
Preauthorization. It’s the bane of physician practices everywhere that are under more pressure than ever to keep costs down. But it’s also a source of frustration at health insurance companies.
“I ask, ‘why are we requiring a prior authorization on that particular service that we approve 100% of the time?’ Why would we require the member disruption, the provider disruption? It makes no sense,” said one payer executive at the event. “But we’ve been doing it that way for 20 years.”
Added another attendee: “There’s a certain mentality that says throwing up barriers to preventive care is a win.”
Help physicians get paid
Meanwhile, with the increase in the number of patients who have high-deductible health plans, providers have suddenly found themselves in an uncomfortable role: Asking patients for money.
“The system was set up so the insurance company is the fiduciary and the provider is the deliverer of the care. [But] those lines have gotten blurred because of high-deductible plans,” noted one attendee.
Some payers are taking on that patient collection role, adding cost-sharing to members’ premium bills and collecting it on behalf of the provider. When patients get a bill from their provider, they often put it aside and wait to compare it to their insurance company statement.
“So right away, providers are out 30 days,” said one attendee.
While payers cannot take liability for the balance due, they have a psychological collections edge. Members are worried their insurance will be canceled if they don’t pay. A doctor’s bill doesn’t carry the same weight.
Helping physicians get paid can differentiate a health plan and “how that provider engages with you versus another health plan,” one insurance executive said.
Take paperwork off physicians’ plate
No doctor goes into medicine to do paperwork. Payers that want to build a good relationship with their network of physicians can make a big difference by getting them back into the exam room.
“If you can take away administrative challenges from the provider, they really look at you differently,” said one attendee. “We try to figure out if there is anything that can go to the office staff to handle instead of” physicians.
One place to start: Nonclinical tasks—especially those measured on quality surveys. Offer tips and tricks, such as using computer screensavers to deliver information about preventative measures or reminders to ask the physician about certain conditions.
Reconsider relationships with alternative care providers
Massage therapy, acupuncture, chiropractic care. When health insurance executives hear those words, the next phrase that often comes to mind is “fraud, waste and abuse.”
Alternative care providers would argue that they can partner with primary care physicians to coordinate care and help payers control costs by avoiding expensive tests, procedures and drugs.
But getting paid is a special kind of challenge.
“They want to control access, which makes it really hard on the practitioner,” said one alternative care provider who attended the event. “We keep running into organizations whose whole goal is to create these utilization management structures. It makes it really hard for patients to access care and for providers to deliver care.”
But that’s not what plans are looking for, he said. Why not make it easier to offer expanded treatment options?
That question touched off a debate among our attendees that suggests attitudes toward alternative treatments might be changing—just not very quickly.
It’s “a much bigger conversation about attitudes in Western culture to holistic practices,” one payer executive said. And there’s also a political cause for the hesitation. “There’s a lot of money in our industry coming from pharma,” she said. And that influences the attitudes of practitioners.
Address the opioid epidemic
Several attendees expressed concerns that alternative care is susceptible to abuse. “I spend more time saying no than yes. We have to make sure it’s legit,” said one.
“But what’s better—opioid abuse or people who abuse chiropractic?” another attendee responded.
Focusing on those at risk for abuse and high-cost overutilizers is one place to start. But to build a population health model that provides alternative treatments for patients who are on the cusp of abuse would require evidence-based protocols. And though research is trickling in, it’s not there yet, the group agreed.
One solution: Ask the physicians in your network for recommendations. “We get our docs to say who they’re comfortable with and then we’ll capitate with a number of people rather than everyone. There’s an opportunity at a smaller level, with grassroots health plans, to look at population health management for those who are suffering from chronic pain and are willing to look at holistic treatments to avoid being a number in the opioid epidemic that has struck our country,” one payer executive said.