Fixing health care at the community level

While facing the ongoing and worsening challenge of reining in health care costs, it’s critical your clients understand the influence they have in transforming health care, controlling plan options and improving affordability. But the success and sustainability of these efforts rely heavily on partnerships created within the system: productive engagements with providers, health systems, health plans and even other employers that share this vision. Here’s an overview of what you can do.

The allure of alliances

Since traditional health insurers bring in billions each year, there’s little incentive for many of them to lower premiums for employers or negotiate the best rates for value-based providers. This is why it’s incumbent upon employers, who hold the purse strings, to demand more. And that starts with engaging new types of collaborations for shared solutions, like working more closely with providers and their health plans. 

Proactive strategies built around strong alliances can help:

• Employers negotiate directly or work with their health plan for better per-unit costs with quality providers and hold providers accountable for improved outcomes and quality of care
• Providers improve clinical and data access and spend more quality time with patients
• Patients get easier access to comprehensive health services within an integrated system and the health benefits of seamless, coordinated care 
• The system reduces fragmented, redundant care to lower costs and improve outcomes

How to start connecting

Brokers and advisors can help clients get started by taking stock of what’s important to their employees and their company. Is affordability the pain point? Access to care? Specific health care gaps to address? And are there certain types of services or solutions that would meet those needs? (This is where the deep data transparency of a self-insured plan can provide would be essential.) 

Next, get to know their local providers with aligned incentives (such as value-based care) who have the metrics to prove it. How do you know who these providers are? The health plan is a good place to start engaging with them, so it makes sense to work with a plan that has experience supporting these types of relationships, as well as a shared vision and the willingness and flexibility to innovate, which can be a tall request for traditional carriers. The plan should know which providers are focused on value-based care and population health and are being held accountable for the quality of care delivered. 

Increasingly, health care providers are eager to work more closely with employers to build upon the foundation that “health care is local” and that fixing the system begins at the community level. To engage a local provider directly, a helpful first step can be asking for education to be given, virtually or in-person, to employees on a critical topic, such as COVID or the importance of colon cancer screening.

For employers who believe they might not have the size and scale for providers to create special programming, aligning with like-minded employers can get the providers’ attention. By partnering with other employers in the area, they can increase the number of potential patients the provider will touch, making the relationship even more beneficial.

The business case for partnerships

When employers forge a stronger partnership with those responsible for their plan and their care, it’s a bold step, with bold rewards:

• It just makes sense: A better aligned health care system is healthier for business. When employers and providers promote accessible, quality care where value trumps volume, patients can get the care they need before small issues become costly problems. 
• The bigger picture can lower the bill. In a coordinated system focused on population health, providers are able to capture more of a person’s end-to-end care than when patients are off navigating a broad, disjointed health system. That enables informed and timely care decisions and presents health plan sponsors with a valuable lever for managing total cost of care. 
• Price matters, but not above all. A productive, promising partnership is not about price shopping. It’s a key part of the equation, for sure, but it’s also moving care to the right places at the appropriate time. A partnership that centers around investing more in quality primary care up front, for instance, typically translates to less spending on inefficient care such as unnecessary inpatient admissions and ER visits. 

We asked the benefits manager at one of our employer-clients to describe how they would explain the benefit of getting closer to the delivery system to their CEO or CFO:

Financially, it aligns with our values. It’s going to align with profit goals. It’s going to create retention. But at the end of the day, it’s about our people, who deserve the best. And I’m going to get them quality health care with great doctors and great hospitals. They deserve nothing less than that. 

Are your clients ready to talk about health care and their commitment to a better system? It’s not hard to build a strategy around that.

Laurel Pickering is Director of Strategic Growth Development at Centivo, and former President and CEO, Northeast Business Group on Health.