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3 Takeaways: Lessons Learned
3 TAKEAWAYS
Lessons learned from RISE West 2019 on provider engagement, payer-provider collaboration, and the real reason seniors choose MA plans
Nine Medicare and Medicare Advantage beneficiaries joined Kathleen Ellmore (front row, second from left) for the focus panel.
Photography: Debbie Weidrick
SAN DIEGO—More than 450 attendees gathered at the Loews Coronado Bay Resort in San Diego for RISE West 2019 to learn about payer/provider collaboration, leadership, and the member experience. Below are takeaways from select sessions:
Seniors reveal star ratings are not a big factor in plan choice
Nine seniors participated in a focus panel moderated by Kathleen Ellmore, managing director of Engagys, to provide insight into their experiences with the Medicare and Medicare Advantage markets. One of their biggest reveals may be a bit discouraging for health plans that have worked hard to achieve a 4- or 5-star rating: The number of stars didn’t factor into their decision to pick a plan.
Indeed, seven out of the nine seniors said they never heard of stars. The two who did hear of the them said they didn’t consider them when choosing their plan.
What does seem to matter: Cost, supplemental benefits and a personal touch.
For example, one senior said he picked his plan because it included a gym membership, as well as benefits for over the counter (OTC) prescriptions, contact lenses, and dental care. Another complained she is paying more in premiums this year but was frustrated that it didn’t offer a silver sneakers program.
Another said he is totally satisfied with his plan. He was especially impressed that the carrier provided a breakfast where he could get more information. He felt good about the time they invested in him, especially when a sales person gave him a business card with his personal cell phone number if he had further questions. Although he’s been on Medicare Advantage for 18 months, he has only used the Silver Sneakers benefit and the quarterly OTC benefits.
“I love that there is a recognition of being healthy, and they continue to give me the option to stay healthy,” he said. “It’s been a great motivation.”
Provider engagement should be a ‘team sport’ and a partnership
Cheryl Babo, director of risk adjustment, Stars and provider engagement, Regence Health Insurance, presented a program on how to revolutionize your quality strategy through enhanced provider engagement. Her advice is to not think about it as a separate department. Rather, consider it a team sport in which everyone participates, and no one is a spectator.
“At Regence we see compliance and ethics as a team sport, and we are trying to implement a similar culture for risk adjustment, quality, and Stars so everybody understands that they are part of the game,” she said.
This means leveraging your internal relationships to get them engaged in activities. If you don’t develop those relationships, your success rates won’t be as high, Babo said.
Part of the problem is that providers are often looking at multiple programs and getting different messages, according to Stacy Garrett-Ray, M.D., vice president, medical director, population health services organization, president, quality care network, University of Maryland Medical System, who spoke about provider engagement during a separate session. She suggested finding ways to align those messages.
Shannon I. Decker, Ph.D., executive director of risk, NAMM California, part of OptumCare, UnitedHealth Group, agreed, noting sometimes health plans make the mistake of telling physicians and providers what to do and what they need from them. Instead, she recommended that they listen to what the providers need from them.
Donna Malone, PC, CRC, senior manager of enterprise risk adjustment, HCC coding and quality assurance, Tufts Health Plan, also noted that health plans sometimes interpret the phrase provider education too literally. Providers have been to medical school and know how to care for patients. Instead, she said plans need to focus on the fact that providers are already doing the work. They just need to explain why and how providers can capture that work, so they get credit for it.
But without trust, payer-provider collaboration will never happen
Amy Nguyen Howell, M.D., chief medical officer for America’s Physician Groups, the largest professional association representing physician organizations across the country, said research shows that true payer-provider collaboration leads to improved patient outcomes. Instead of volume, collaborative payers reward providers for increasing the value of care. They care about the primary care provider’s outcomes because their economic fates are tied together.
But trust is vital to foster and help execute collaboration between payers and providers. “If you don’t take the time and energy in building trust between a provider group and payer, it’s not going to work,” she said.
She advises health plans to begin building the foundation of trust by thinking about what motivates physicians. Not everyone is motivated by money, but one commonality that all physicians share is that they have built their careers around their patients. They care about patient outcomes. “If a physician group doesn’t trust that you have the best interest in mind of the patients, nothing will move forward,” Howell said.
However, if a payer focuses on patient outcomes as its true mission, it will align with the goals of physician leaders, and you can use that as a platform in negotiations. “At the end of the day their goal is to improve the quality of care of their patients, not to make the health plan richer,” she said.
Howell encouraged plans to create a buddy system and provide physicians with the name and home and cell phone number of someone from the payer side that they could call when they have a question. “It’s as simple as that to start building trust…Part of communication is sharing information. Buddy groups do work,” she said, noting that the partner can call his or her payer partner to find out what they really need to do to improve programs, such as star ratings and medication adherence.
