Industry Voices—Payers: Expand your partnership mindset

A mature woman physician consulting with a patient in the doctor's office.
Transforming healthcare starts with gaining patient trust. (Getty/Ridofranz)

Whether you’re a commercial payer, Medicare contractor, health system executive or practicing provider—or some combination, like me—we’re all in the business of taking care of the patient.

But throughout the last decade, the priority of the patient has taken a back seat. Many factors have contributed to this change. Healthcare reform continues to confound billing departments, physicians and patients with increasingly complex regulatory requirements, making it difficult to bill and collect on services rendered. With national healthcare expenditures accounting for 17.5% of gross domestic product, hospital expenditures increasing by 4.1%, and physician and clinical service expenditures rising 4.6% in 2014, the pressure to maximize patient foot traffic through our doors has never been stronger.

Muddled under the financials, we lose sight of the patient. The U.S. spends more on healthcare per capita than any other developed nation yet is at the bottom of the spectrum in patient outcomes.

Conference

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.”

This means something isn’t working. As an industry, we must go back to a patient-first mindset. We must focus on the basic human values that remind us why we took the oath and dedicated our lives to the service of others.

Succeeding in today’s dynamic healthcare environment requires, first and foremost, the trust of the patient. And trust can only be built through bettering quality and providing convenience and access to the right healthcare options.

Trust is built by truly being a value-based healthcare organization.

RELATED: America’s Essential Hospitals launches research project to identify ‘dimensions’ of patient trust

To restore patient trust in healthcare, likeminded entities need to come together. Transparency among multiple health system partners is needed to change the way healthcare is performed today, and it starts with our partners. The partners you choose to work with must be organizations you can closely collaborate with to earn the trust of the patient.

I believe urgent care centers should be included in this partnership equation and are a valuable component in directing patients to the right site of service.

Established to treat non-life- or limb-threatening situations, urgent care centers are transforming affordable, accessible care. With the right data, providers will be able to provide thoughtful, research-backed referrals so they can guide patients through an entire episode of care.

And with the patient’s trust, they can influence where the patient goes for aftercare. This data from multiple health partners is essential to create a seamless experience for the patient and meaningful cost savings. If payers can demonstrate that quality outcomes for a service are the same but one is at a lower cost, then health system partners can recommend for the patient to set up an appointment with the more affordable provider. Thus, both the patient and payer save crucial healthcare dollars while keeping the same high level of care.

RELATED: Patient-centrism: The data-driven trend to watch in healthcare transformation

This high-quality, cost-savings referral is only possible through both the earned trust of the patient and the data from payer and health system partners. Empowered with this information, urgent care centers and the healthcare industry as a whole, can increase access (to the right, in-network provider), increase quality (through empowered referrals) and lower costs (by making referrals based on being in-network, visit fees and outcomes).

The understood savings to insurance partners is critical to the discussion around and the design of value-based programs such as the ones implemented by urgent care centers across the United States.

Affordable, quality care options save money for everyone and are highly achievable in an interconnected healthcare system. Through our partnerships with payers, we become higher-value providers by maximizing the data they share. When this is accomplished, it’s not just the patient and payer who see the value, but society overall.

Richard Park, M.D., is founder and chief executive officer of CityMD, the leading urgent care provider in the New York Metro Area and Seattle, Washington. 

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