Tips for getting provider collaboration on the pay-for-performance healthcare

As I talk with our healthcare payer clients about pay-for-performance models, I often hear the same questions:


“How do I get providers to feel more comfortable about value-based incentives?”


“How can I convince providers to see our plan as a partner in improving quality and health outcomes?”


“How can I ease concerns about the transparency and technology involved in quality-based reimbursement?”


To be honest, you can’t force your provider partners to hop on your bandwagon. However, you can take the steps below to honor their concerns and ensure you’re on the same page. For more tips, download our guide: 6 Ways Payers Can Help Providers With Value-Based Reimbursement Models.

1. Acknowledge all the factors that impact quality of care

Providers often balk at pay-for-performance models because they don’t want to be judged or punished for something they can’t control. Acknowledge that patient behavior is affected by socioeconomic and psychosocial factors, as well as what the provider does. Your outcome-based models will be more palatable if they reflect the reality that many factors impact quality of care.


2. Provide data that helps providers understand and act

Take a look at the data you deliver to providers. Now ask yourself – honestly – how it helps them close gaps in care. The key is to provide data in an actionable form (for example, a dashboard view) rather than large data sets or files.


3. Connect interdisciplinary care team members

If you are participating in government-sponsored programs, you are responsible for developing Individual Care Plans that includes the member, primary care provider, specialists, and others as appropriate. To the best of your ability within your compliance requirements, use your technology to be conduit for information rather than a barrier.


4. Support self-management

Using web and mobile tools, you can provide members with access to self-management resources. For example, give members the ability to track their health, review the results of recent visits, and manage their prescriptions. Provide outreach through the phone, email, employer intranets and other methods to close care gaps – and reinforce the need to close them.


Chuck Rolfsen is Chief Revenue Officer for Healthx. He helps Medicaid health planscommercial health plans and other Healthx clients develop strategies to streamline administrative processes and improve the quality of care.