'Secret sauce' to payment reform is provider collaboration

AHIP 2012: Experts call for face-to-face contact, care coordination with docs

To successfully reform payment methods, payers must engage in true and meaningful collaborations with providers that move beyond simply altering payment structures to incorporate care coordination, the right information and better incentives for providers, according to Mary McCluskey, chief medical officer and executive vice president of Amerigroup.

"It's not 'us versus them,'" she said during a Thursday session of the AHIP Institute in Salt Lake City. "We are truly partners with physicians."

Copanelist and Cigna Senior Medical Director Robert McLaughlin said the keys to successful payment reform include face-to-face contact and care coordination with physicians. "These are the secret sauce to developing a high-value healthcare system," he explained.

To enhance relationships with doctors and hospitals, payers should provide an integrated clinical support system, including coordinated staffing resources that support, educate and empower patients to self manage their care. For example, an embedded care coordinator, such as a patient advocate, can ensure personal, patient-centered care is provided--a tool that works toward the overall goal of providing high-value care.

"The care coordinator is the lynchpin to payment reform," McLaughlin said.

Insurers also must select the right information to give to providers, avoiding "data overload," which leads to doctors not reading any of the information.

"You can't just throw information at doctors," McCluskey said. "Instead, present data in a way so that doctors can digest and manage information."

For example, McLaughlin recommended that insurers provide doctors and hospitals with specific information to drive management decisions, including information on system changes, population health data and day-to-day information that affects patients in real time.

But even the most trusted and meaningful relationships won't deliver high-value care unless payers properly incentivize providers.

"Simply offering increased compensation doesn't give doctors the tools to deliver high-value care," McLaughlin said. That's why payers should gradually introduce new payment strategies so providers develop an "appetite for risk" and see the opportunity afforded them through value-based payments.

"You must take a graduated approach to introducing new models to providers," he added.

They key to incentivizing providers? "Don't just dump risk on them," McCloskey said. "Provide the tools they need to be successful."

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