Successfully engaging providers and their staff can have a dramatic impact on health plan performance. Health plans find that involved providers lead to improved clinical outcomes and quality ratings, member retention, and overall efficiency. Achieving meaningful provider engagement requires alignment between the quality and financial goals of the health plan and the quality and financial goals of the provider practices. The essential elements to provider engagement with the goal to improve quality and disease coding include the following:
- Increased adoption of gap-closure activities. Given the right tools, providers can use point-of-care decision support to close care gaps. These systems give providers full access into a member’s profile, including prior assessments, documentation, and care-gap reports. This right-time, right-place information helps providers to have a more complete view of their patients’ health status and provide a greater impact on gap closure.
- Improved interoperability. A complete view of the patient’s prior care is essential to improving care and reducing unnecessary treatment. Providers must be able to quickly view medical records, regardless of where they are located and what electronic health record (EHR) they were created in.
- Use of data-driven best practices. Knowing the right questions to ask and being able to tap into data-driven insights leads to more targeted interventions for patients and more efficient use of a provider’s time. It also decreases unnecessary tests and treatments, increasing provider and health plan financial performance.
The following are several important best practices for achieving provider engagement:
- Clear communication. Successful health plans clearly communicate both the complete vision and the specific goals needed to achieve it. Frequent dialog with providers is essential for those goals to become mutual.
- Targeted outreach. Savvy health plans have a system for regular, targeted outreach to providers that will remind them of important dates and milestones and encourages participation. Health plans can take a multi-channel approach and use the preferred communication channel that each provider requires.
- Decision-support tools and interoperability. Data underpins every potential improvement for providers. When health plans provide technologies that provide decision-support and data-driven insights they empower the providers to maximize their effectiveness and care quality. Working with providers time constraints, health plans offering training and support enable better provider understanding of data insights gleaned from these resources.
- Provider incentives. Changing provider practice patterns is a difficult task, but health plans using the right incentives are achieving goal alignment and seeing improved outcomes.
Health plans that consistently communicate a clear vision with specific goals to providers leveraging intuitive technology with data-driven insights are able to achieve efficient, actionable provider engagement. Those providers are then able to improve both quality outcomes and financial performance.