Kim Francour on December 3, 2015

Payer Co-opetition Needed to Improve Provider Interactions

Francour_Kim.jpgThe health insurance marketplace is more competitive than ever. So, is collaboration between these competitors, or “co-opetition”, appropriate? I think so—especially when it benefits consumers without negatively impacting the payers.  To illustrate what I mean, let me borrow first from a different industry that everyone can relate to: Retail. Having recently relocated from Madison, Wisconsin to Boston, I have used my credit card in many new places as my family and I have explored the activities, stores and attractions our new home has to offer. However, as my credit card transactions have increased, so too has my frustration over why there isn't a standardized way to pay for goods at the point of sale. In other words, every credit card “swiper” is different and requires a different set of steps, and in a different order than the others.  It seems to me that standardizing the shopper’s experience would benefit consumers without significantly affecting the competing companies behind these payment devices.  Yet, this would require collaboration between competitors.  It begs the question: As more and more of our daily activities and experiences become automated, will standardization and simplification of these activities and the devices we use to conduct them ever become a competitive advantage?

Consumer/Provider Frustrations in Healthcare IT

Shifting back to healthcare, this same idea can apply to online portals, and in particular provider portals. The lack of standardization across all the health plan portals available to provider offices is actually quite similar to those frustrating, disparate point of sale systems.  From a health plan’s perspective, its provider portal was developed to meet the custom specifications of the health plan, and most aim to yield smooth communication and transactions with the end-users at the provider’s offices within the health plan’s network.  However, as we found in our recent provider office survey, 43% provider offices regularly must work with six or more unique portals.  And just like swiping your credit card when you pay, each health plan has its own unique portal and distinct workflows that are far more complex than the basic point of sale device analogy.  These providers and their office staff directly influence quality scores like HEDIS or Medicare Advantage Star Ratings, unnecessary readmissions, and inappropriate ER utilization. This is important work, which means that simplifying and standardizing the provider workflow across these portals has the potential to have a significant impact.  End-user experience is key to user adoption and utilization, so no matter how wonderful the innovations and technologies being built into individual portals might be, payers need to work together to evaluate the areas that should be standardized and simplified when collaborating with providers. CreditCardSwipe.jpg

Payer Co-opetition?

Heading up the Sales team at NaviNet, my unique position provides me with opportunities to meet with various payers and providers across the country to learn their challenges. From this vantage point, I have noticed that payers are recognizing that collaboration with other health plans has the potential to improve both collaboration and efficiency within their own provider network. This was quite evident during The Millennium Alliance’s Healthcare Payers Transformation Assembly in Coconut Grove, FL in October. This unique conference fosters dialogue from a broad range of viewpoints to determine how to navigate through the very complex path of establishing value-based care within healthcare, and allowed me to meet with healthcare leaders from both the payer and provider market space.  After several meetings, it became apparent that there is a growing awareness for greater collaboration between payers in order to optimize payer-provider collaboration

Start Payer Collaboration with What Providers Need

Without a doubt, payers who choose co-opetition and elect to collaborate together on simplifying and standardizing payer-provider interactions will gain a greater response from providers and ultimately generate better care for their members.  Below are three steps payers can take together to improve interactions with providers:

Step 1: Reach out to Your provider network.

Payer co-opetition starts with understanding the needs of shared provider offices.  Surveys are great but it’s also important to visit in person. One plan we talked to goes onsite to provider offices and observes each office’s various daily workflows.  As you reach out to your provider network, ask:

  • What do provider office users need, want, and like in their workflows and portals?
  • How do the offices manage routine administrative and clinical transactions?
  • What are the areas that payers can work together to improve the user experience? 

Step 2: Determine What Tasks and Transactions Providers Complete Across All Plans.

Also, be sure to assess the following:

  • What are the issues that hold up or delay these common transactions?
  • Which activities cause providers to call a plan?
  • What are the pain points when navigating across multiple portals? 
  • Are there transactions that should be standardized so that they can be completed more efficiently? 
  • Is there true value in keeping these workflows non-standardized?

Step 3: Find and Engage with Other Health Plans That Want to address Standardization.

This will require some networking:

  • Attend local health plan associations meetings
  • Join health plan coalitions
  • Invite other health plans to collaboration sessions 
  • Define and participate in opportunities to share best practices and problem-solve together

When it comes to payer-provider collaboration, it can only go so far unless health plans that typically compete come together to improve their interactions across providers.  It is my hope that payers (and those frustrating point of sales systems) will align and challenge the status quo to accelerate improved quality for consumers.

Need to improve your health plan's provider interactions? Read our Insider's Guide to Payer-Provider Collaboration

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Tags: health plans, Industry Events

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