Provider participation in value-based care is key to patient health improvement. Everyone knows that, but why is it so challenging for health plans to achieve? After all, value-based care enables providers to improve patient outcomes and health while increasing their revenue at the same time.
Why wouldn’t providers want to participate?
Seems like much has been written about how to get providers engaged. There are many articles out there with long explanations and multiple-step processes for reaching out to providers, but there’s a simpler solution – a pipeline and network to support payer delivery of quality information to their providers at the time of care.
Providers Want to Engage but Need Help
Many health plans have indicated to Payspan that they have gap closure rates in the 3-5% range, which shows that providers are struggling to implement quality measures.
That’s because providers need help interpreting and applying complex payer quality contracts in real-time as they are seeing and treating patients. This is true especially for smaller practices that are strapped for resources and time.
Nearly 80% of providers and healthcare executives who responded to a 2016 survey said they believe that most physicians really don’t know the quality measures for each patient, but 74% said that receiving clear communications and guidance from health plans would help them implement value-based care.
What this means is that payers have the opportunity to simplify and clarify the process for their providers.
Provider Networks: A Pipeline for Quality Communications
Payers are already communicating with providers about claims and reimbursements via a secure network. Why not use this network to share documents as attachments, as part of the flow of information?
- When claims arrive, payers could identify care gaps and then alert providers.
- Payers could provide guidance on the quality measures needed to close the gaps.
- Communications could inform the doctor about incentives for taking action.
- Providers could receive the alerts and guidance at the point of care.
- Support staff could share proof of care-gap closure with the payer.
- Payers could use the secure payment network to pay the financial incentives.
- Payers could share reports that list all the patients and their care gap status, whether closed or still open, and the amount of available financial incentives.
This simple process could accelerate the adoption of value-based care by providers, but how can payers make this happen? Payspan’s Quality Incentive Communications System (QICS) can take all this on for health plans.
Payspan’s Solution Does All the Work
Like providers, health plans are also strapped for time and resources. Building a communications infrastructure and implementing a program to present quality information in a simple, easy-to-read format would be a daunting and high-cost challenge.
Health plans would not have to worry about infrastructure or program implementation with QICS. Built on the largest healthcare network that includes 1.3 million provider payees and 600+ health plans, QICS takes raw data from health plans and organizes it into clear, visually appealing messages that providers can easily act on while treating the patient.
Health plans transmit these communications over the existing network and engage in a two-way exchange of information about patient-members with physicians to close care gaps, implement quality measures and award incentives. We estimate that health plans implementing this program can increase their care-gap closure rates from below 10% to 80% or higher.
Payspan also uses provider enrollment best practices to get physicians on the network and enrolled in the QICS program, so health plans don’t have to worry about that either.
It’s really that simple.
QICS has the power to help health plans and payers build partnerships that result in better patient-member outcomes, lower costs for health plans and increase revenue for both health plans and their providers.
 Innovalon/Quest Diagnostics, “Finding a Faster Path to Value-based Care,” June 2016