05.13.19 Insights, Press

The Fight to Keep the Long-Tail Engaged: How payors can motivate independent providers to improve quality and financial performance

It’s a simple fact: the U.S. healthcare system has experienced a seismic shift since 2010 that’s made it difficult for independent providers to keep their doors open.

While many independent providers were pulled into hospitals and health systems due to powerful market forces, like the Affordable Care Act and its demanding EHR and reporting requirements, there are still those who continue to hold their ground in the changing healthcare landscape. In a 2018 benchmark survey, The AMA found that 46 percent of physicians are still independent practice owners or partners. While that percentage has declined in the last decade, recent surveys have shown this consolidation to be slowing down.

And, let’s face it, independent providers still matter to payors. From my work with many payors, I’ve consistently seen that 40-50 percent of a payor’s book of business is still running through independent providers. It’s obviously critical for payors to effectively engage their long-tail providers to improve quality and cost. What might not be so obvious is the best way to do it. Given that collaboration between payors and providers isn’t the norm and the relationship can often be contentious, opportunities to have productive discussions are often missed.

So, how can payors better engage providers?

1. Be clear about incentives and activities.

It won’t be easy, but payors must identify ways to motivate providers for the right activities. Laundry lists of required activities that don’t fit with provider workflows put tremendous stress and financial pressure on the practice. Care management fees and annual shared payouts miss the mark on incentivizing those providers who are working hard to improve health outcomes and drive down costs. Payors need a way to effectively communicate what activities can improve quality scores and properly incentivize providers for taking the right steps at the point-of-care.

2. Leave no doc behind.

Not all providers are the same. With varying levels of experience and expertise in value-based care, technology and business acumen, payors should be willing to help low-performing providers troubleshoot and evolve. By determining which providers need extra support, and empowering them with easy-to-use tools, everybody wins — Providers practice closer to the top of their license, patients receive better care and payors shoulder less costs.

3. Take the burden off of the physician.

Physicians are working more hours and seeing fewer patients. According to the 2018 Physician Foundation Report, 80 percent of providers reported being at full capacity or overextended, with 23 percent of their time spent on non-clinical paperwork. The solution: Leverage technology and motivate a providers’ support staff to handle the majority of the non-clinical work, leaving providers more time and energy to put toward patients.

4. Bring in Switzerland.

Too often, payors and providers sit on opposite sides of the fence, unable to trust that they can play for the same team. Unfortunately, this history is difficult to overcome, and sometimes, a reliable ally working in the background to help facilitate stronger relationships is essential. If payors can identify the right partner – one with tremendous technical expertise and industry knowledge — that providers trust, a bridge can be built to improve care, lower costs and enhance the provider experience.  

Conclusion

What does it all mean? There is a way for insurers, providers, patients and taxpayers to win. Re-invent the RVU at a national-level, before it’s too late.

What if life was easier for everyone involved? What if independent providers who were historically low-performing became an asset to payors? And, what if providers got a better handle on how the “new game” works, and became better participants in the system?  

No one can do it alone.  At Stellar, we take the guesswork out of value-based care in order to engage the unengaged. Our software platform alerts providers, at the point-of-care, so patients receive the right care at the right time. Our solution flags opportunities for better care in real-time, such as illuminating incomplete preventative screenings or coding gaps. Providers and their staff are immediately rewarded for their work.

What we do isn’t simple, but our mission is: Take the burden off of payors and providers so everyone can focus on what matters most — ensuring patients get the best care possible while lowering the total cost of care.

Learn about what we can do for you. Contact us for a consultation.
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