Five Steps for Payers to Enhance Provider Enablement

By SpectraMedix Team

When we discuss value-based care, the “value” component is intrinsically tied to the success, or lack thereof, of your provider network. It’s because of this that provider enablement is a key point of emphasis for health plans entering into the value-based care domain. But what is the actual process through which payers can better and more reliably enable their providers to be successful within the terms of their contracts? In our experience, there are five steps for payers to enhance their provider enablement strategy:

1. Goal Alignment and Transparency

Considering that payers possess most of the data (cost and utilization metrics, etc.) that power value-based contracts, it’s ultimately their responsibility to take the lead when it comes to maintaining transparency with their provider networks. That responsibility presents a challenge that payer networks must determine the answer to themselves. When communicating with providers, what should payers share and what should they not share? When determining your organizations desired level of transparency with providers, it's important to prioritize giving them enough information and context to properly understand the terms of the contracts they have entered into. Transparency early on will spare you confusion from providers in the long-run.

2. Delivering Actionable Analytics

Transparency with your providers is key to enabling them for success, but transparency alone is not enough. It’s important to support your providers with analytics, including quality, cost, utilization and financial metrics, throughout the duration of the contract. When we hear from our payer clients about provider transparency issues, it often has less to do with their understanding of the contract terms and much more to do with them wanting to better understand how they can improve their real-time results. Providing granular analytics beyond total cost of care and providing them on a monthly basis will empower providers to succeed in executing their contracts.

3. Enabling a Population Health Paradigm

Providers, not payers, are the ones on the front lines of patient management and care. With all of the patient population data (claims data, social determinants of health, community health markers, etc.) now available at the system level, giving providers access to this data and making sure they have the right tools to leverage that data is essential to provider enablement. Advanced analytics tools such as predictive modeling will empower providers to improve patient care and provide preventative treatment to their overall patient population.

4. Streamlining Workflow and Reducing Administrative Costs

As providers are shifting more and more into value-based care, there are a lot of adjustments required of them. Because of this, it’s important when thinking about enabling your providers that you meet them on their level. One of the clearest ways to do this is to integrate your data and analytics into their existing frameworks and operating systems. Payers engaged with providers should be thinking about interoperability, which will increase provider access to data and in turn make them more effective at leveraging the data provided to them in their treatment of patients.

5. Timely Incentives

In the past, financial incentives for providers in value-based contracts typically came only at the end of the contract term, which meant waiting a year or even longer for any payoff. A more beneficial model for payers to consider is to offer providers incentives on a quarterly or real time basis based on gap closures and other such metrics. Creating an infrastructure where providers are incentivized on a rolling basis and not merely at the end of the contract will keep them more engaged in delivering quality care throughout the contract. It will also serve as a mechanism for direct feedback on their overall performance.

We’ve covered provider enablement before in the webinar “Provider Enablement in VBP: Making Payer-Provider Value-Based Payment Models Work,” which this blog is based on. If you’re interested in taking a deeper dive into the topic, please check out the full version of that webinar here.

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