Accessible Data, In-Person Dialogue Key to Value-Based Partnerships

November 18, 2019 - There are two elements of value-based care that should come as no surprise to a seasoned healthcare professional regarding value-based partnerships. First, that payer-provider relationships are at the heart of successful value-based care and, second, that these relationships are often a source of friction in value-based contracting.

Although payers have recognized the benefits of value-based care, particularly in cost and quality, without a strong provider network these benefits will go untapped.

For providers, it is challenging to adapt to the new mindset that value-based care demands, Larry Blosser, MD, outpatient medical director at Central Ohio Primary Care Physicians, told attendees at the Xtelligent Healthcare Media’s Fourth Annual Value-Based Care Summit.

Value-based care arrangements require providers to identify the data that they want from payers, the best ways to receive that information, and how to implement it. Providers are unaccustomed to considering these factors, he explained.

Complex payment models also stand in the way of payers developing successful payer-provider partnerships, added Worthe Holt, Jr., MD, vice president of the office of the chief medical officer for Humana, which contracts with Blosser.

READ MORE: Payer-Provider Partnership, Data Management Promote Population Health

Building providers’ trust in a payer and parsing out the details of a value-based contract can be time-consuming and may cause friction between the two parties.

In order to achieve a working relationship, the pair agreed that data and communication are key.

Providers Seek Payer Insights That Are Actionable and Accessible

Data distinguishes a value-based care payer-provider relationship from the fee-for-service model. But collecting data is insufficient for developing a successful value-based care environment.

“We, as a group, have just always said, ‘we want data, we want data, we want data,’ and then all of a sudden you get somebody who gives you data. Now you're like, ‘what am I going to do with this?’” Blosser explained. “It is really important to be able to understand the data you're getting. I don't think any of us, as physicians, were ready to do that. I think we had to add that capability, ultimately,”

That is where Humana stepped in. Early on, before Central Ohio Primary Care Physicians started taking on downside risk and diversifying their payers in the Medicare Advantage space, Humana not only offered the provider organization data, but also interpreted the data to help the provider target the best solutions.

READ MORE: Strategies to Improve Payer-Provider Relationship, Data Quality

Humana’s data allowed Central Ohio Primary Care Physicians to identify utilization patterns, the costs of those patterns, and the best resources for patients.

The most beneficial insights and analytics resource for Central Ohio Primary Care Physicians has been patient-specific quality care gap information that the physician views in a dashboard, Blosser said. The provider combines EHR data, payer data, and a nurse’s analysis of potential quality care gaps and develops the dashboard displaying all of that information.

It’s important for Humana to know that Blosser and his team like this dashboard, or the preferences any of their contracted providers have for viewing data. This helps Humana combat the challenge of disseminating hoards of patient information.

From the payer’s perspective, Humana has no shortage of data with its vast stores of patient information that automatically updates every night, Holt disclosed. But delivering that information to primary care physicians, nurses, pharmacists, and other healthcare professionals in an interoperable, ergonomic manner was a serious challenge.

Technology presented one method of managing Humana’s insights for providers.

READ MORE: 3 Key Strategies for a Successful Payer-Provider Relationship

Recently, for example, Humana and Microsoft entered into a seven-year contract to develop an application program interface (API) capable of organizing health data in a cloud and transferring insights into a mobile setting.

Holt also noted Humana’s partnership with Epic, an effort to lower prescription drug costs and streamline the e-prescribing process.

However, in the face of mounting pressure to turn to technology to solve value-based care problems, Holt also noted the value of relaying insights and gauging provider needs in face-to-face conversations.

At Joint Operating Committee meetings with Central Ohio Primary Care Providers, Humana builds the relationship by exploring new ways to support providers. The payer asks:

• What challenges is the provider organization facing?
• What types of information does the provider need to help overcome those challenges?
• What did the provider think about recent Humana reports?
• How can the payer improve providers’ access to the information?

Both the payer and provider agreed that data is useful for determining the best referrals. When payers provide utilization data on specialists, providers can quantitatively assess who the most effective resources are for their patients, cutting down on unnecessary costs.

“As we begin to understand what utilization looks like, what cost looks like, we have the ability to direct it to those folks who are creating value for us, for the patients, for the system,” Blosser explained.

Constant Communication Key to Relationship-Building

Apart from data distribution, communication emerged as another key element to the payer-provider relationship.

For Humana and Central Ohio Primary Care Providers, maintaining open lines of communication requires having more than one touchpoint.

The quality nurses that assess Humana’s data to determine where the quality care gaps exist will communicate with their Humana counterpart on at least a daily basis, Blosser said. In addition to that constant interaction, the Joint Operating Committees meet once a month to survey performance and consider potential problems. Even between Joint Operating Committee meetings, members of the payer and provider organizations may conduct phone calls once a week.

One nontraditional method of communication, however, that both the payer and provider encouraged was enabling provider-to-provider support.

Several times per year, Humana coalesces providers at their value-based care conferences, mixing high- and low-performing groups at various points in the value-based care transition. The payer is not present at these conversations.

“Docs want to talk to docs, and we sort of create an environment in a forum where they can ‘go to school on each other,’ as I like to say,” Holt explained. “That's been very effective as well. They learn from each other. They recognize that maybe some things that one group thought were just insurmountable barriers are not that insurmountable after all because Larry figured out how to do it.Then they trade information. We can bring everybody along and we can get people to engage more effectively in these models.”

“Those kinds of opportunities are just really powerful,” Blosser added. “Nobody's got this all figured out; we figured out one little piece over here, but somebody else has figured out this piece that we are still struggling with. When you can get in a room and talk, organization to organization, it's invaluable.”

Ultimately, the payer and provider concluded that mindset is key to overcoming the challenges that payers and providers experience in value-based partnerships. Having an attitude of commitment to value-based care and transparency about ways in which providers can improve and can receive assistance will go a long way in ensuring a long-lasting and beneficial relationship between the organizations.