Payers And Provider Engagement…It Is More Than Sending Letters And Faxes!

by Samir Mistry, Pharm.D.

 

I have worked in the managed care payer space long enough to understand that most payers across the country struggle with provider engagement. But in their defense, provider engagement is not a simple process to manage, and for large national or multi-state payers this task is nearly impossible. There truly is significant untapped opportunity to lower pharmacy and medical costs and improve quality through better engagement with providers. Generally, most payers communicate with providers via letters, faxes and emails, but this is not considered engagement. Provider engagement, or any engagement for that matter, involves two-way conversations. Generally, when a payer makes a decision that involves providers, the provider input is left out, and the decision is communicated via letters or faxes. The only time a discussion occurs is when there is a written or verbal complaint that requires a response. Moving down the path of provider engagement is not simple, but ultimately the rewards are worth the effort.  Ultimately, engagement can lead to adoption and endorsement, which can then drive more effective execution of strategies.

Break the Seal and Meet with a Provider, but Start with a Happy Provider

The worst situation possible is to initiate this process by working with an angry set of providers. Providers have to deal with many payers’ patients, maneuver through each plan’s prior authorizations for medications and procedures while trying to provide appropriate care to patients. It is a daunting process. To initiate contact with a provider, it is best to start with a provider who sees a large number of your plan’s members. It is also recommended that you meet the provider after business hours, away from work to prevent distractions. During the meeting, you want to focus on the following critical topics: discussing new strategies, asking for insight, and inquiring about the challenges and frustrations the provider is experiencing with the members. The most important component of the engagement is to follow-through on any topics discussed by scheduling follow-up meetings. Like any friendship, provider engagement involves maintaining contact, so make sure to keep regular meetings either in person or via phone.

Don’t be Afraid to Ask for Recommendations and Try to Make Adjustments to Accommodate Recommendations where Possible

A well-executed strategy becomes more effective if there is endorsement from those impacted by the strategy. If you create a collaborative atmosphere during the engagement and are willing to accept fair suggestions from the providers, then there is a strong chance your program will have better results and fewer complaints. If you can provide a better provider experience to the strategy, then the adoption will be much faster, which will lead to more timely results.

Develop Regular Focus Groups of Your Highest Volume Practices

When implementing a large-scale program that will impact many providers, it is important to develop a focus group comprised of impacted providers. This will help in designing the best solution and executing it effectively. The focus group should consist of practicing providers who see many of your members and are respected in your region. They will provide a great deal of value in creating the program as well as endorsing your program once it is implemented. It is also important to continue holding these meetings as the program progresses in order to make adjustments to strategies, develop pay-for-performance programs, and potentially drive better results.

Engaging providers in a payer’s program development can create a sense of ownership, which is extremely important to the success of any initiative. Payers do not need to be Staff Model HMOs or Accountable Care Organizations to achieve high levels of provider engagement. Payers can be successful if they are committed to effectively and frequently engaging and communicating with the providers, appropriately using providers’ feedback and suggestions, and improving the overall provider experience. Engaged providers will be happier providers. They will deliver better care to your members, and collaborate to successfully implement your plan’s strategies. The ultimate winner of provider engagement is your plan’s membership.

 

 

Samir Mistry, Pharm.D. is a Senior Manager and the chief pharmacy expert in the healthcare practice at Optimity Advisors.