Somewhere in your town, an insurance agent or third-party administrator (TPA) is telling an employer that the reason for the high costs of health care programs is due to your (the provider’s) high costs. They point to physician’s salaries, the over-ordering of expensive, unnecessary tests and the lack of focus on preventative care to bolster their claims.
Whether or not this is true is irrelevant. Employers believe it. And so it continues, the adversarial relationship between employers and providers.
Improving relationships with employers is a huge boon to a practice’s/hospital’s business. Additionally, a cooperative relationship will yield better, more cost effective care for employees. It is a win-win situation that providers must consider to improve their bottom line.
Once upon a time, it was the health system, not payers, TPAs or other vendors, that provided some or all of these functions:
- claims administration
- utilization review
- chronic condition and large case management
- provider network management
- data mining and reporting
- member services
- benefit plan design
- risk assumption/sharing
Over time, providers abdicated a number of these responsibilities to the payers and TPAs. Juggling the normal management of a practice or hospital is time-consuming enough, so it was easy to give up these activities in favor of spending more time on patient care. Now, for many health systems it is probably unrealistic to try to reclaim all of these activities. The financial investment and time required would be prohibitive on its own but factoring in skepticism from employers would make it close to impossible.
This does not mean that providers should maintain the status quo. While reclaiming all of these activities is not always an option, you can improve your relationship with local employers and perhaps reclaim a few of these activities. An effective employer-provider relationship is an in-depth relationship where something happens every day. This means that daily, not just once or twice a year, you are working with employers and their plan members to identify and implement health improvement and cost savings opportunities. Some examples of activities that you can weave in as you see fit are:
- holding meetings of the provider/employer Health and Productivity Team
- mining data to expose efficiencies
- closing gaps in chronic condition care
- educating plan members about healthy eating
- communicating employer objectives throughout the provider community
There are barriers to these provider-employer relationships that have to be overcome. Often employers already have good relationships with vendors or TPAs and are not looking for a change. Likewise, hospitals and providers are leary of stepping out of their comfort zone and forging an interactive, beneficial relationship with providers.
Managed Care Partners can help you create and maintain a relationship with local employers and form the platform to build your market share. We will discuss this more in our next post.