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Three Essential Ways to Win Q4 for Your Health System

COVID-19 is here and doesn’t appear to be going away any time soon. Most people reading this have been working tirelessly, losing sleep, and making huge sacrifices to make sure their health systems are successful, even when the deck is stacked against them. Health systems are hurting, even with CARES Act funding, while health insurance carriers are profiting big. Today, let’s take a break from the chaotic news of COVID-19 to look at some ways you can potentially set yourself up for major gains in Q4.
 

1. Engage Physicians

If you’re not thinking about the direction of primary care right now, you’re missing out on some key opportunities to boost your health system’s financials. While Walgreens and Walmart are launching large expansions of primary care, that doesn’t necessarily mean health systems will see large losses due to external provider recruitment or patient steerage. Many payors are turning their traditional fee-for-service contracts into value-based agreements with health systems, which increases the monetary upside for both providers and facilities. The backbone of these arrangements, which Walgreens and Walmart aim to promote (think Oak Street or ChenMed), relies on strong physician engagement. Here are some thoughts to keep your physicians happy, and thus your patients happy:

  • Drive value in physician relationships by offering leadership positions on boards or contracting teams to key providers.
  • Create real financial incentives by offering providers a greater cut of shared savings programs for realistic care metrics that align with developing care models.
  • Be data-driven and transparent with that data. Drive physician-to-physician competition.


2. Open the Phone Lines

Now that we’ve shown physician engagement is critical to health system success, let’s look at something COVID-19 has accelerated — telemedicine. Keeping a pulse on your patients should be at the heart of value-based arrangements and managed care. This way, care can be appropriately coordinated from clinic to pharmacy to home. Keeping quality metrics high means keeping quality care at the forefront. Telemedicine expansion is making waves right now, so it’s a no brainer to boost claims revenue and patient satisfaction.

  • Utilizing telemedicine keeps your provider base engaged, including nurse practitioners and physician assistants. This is especially important in managing those patients that have chronic and severe illnesses.
  • While senior telemedicine use is on the rise, there’s still opportunities to be a leader in this space as a health system. A recent study showed that some seniors still had trepidations using these benefits because of disabilities of lack of technological knowledge. Use interactions with this patient population in your clinics to provide education and ease their fears so they seek the care they need.
  • Payors and telemedicine providers are expanding the space with new partnerships. Get on board now to offer leverage in coming negotiations with payors, especially incentive conversations.


3. Grow with Medicare AEP

As you consider physician engagement and retaining patients, remember the Medicare Advantage Annual Enrollment Period – Oct. 15 - Dec. 7, 2020 – is poised to be the largest we’ve seen. We all know that Medicare Advantage plans have grown significantly over the last five years. Similar to today’s telemedicine benefits, Medicare Advantage plans offer a robust set of supplemental benefits that traditional Medicare doesn’t cover, such as transportation, over the counter goods and medications, post-discharge meals, etc. These extra benefits are aimed at improving the health of patients and helping providers successfully manage quality programs that health systems have in place to hit STARs and HEDIS requirements. Aligning your health systems with strong Medicare Advantage payor relationships will help boost revenues in Q4, while covering potential shortfalls in managed care on the commercial side. Some points to think about:

  • Medicare Advantage is growing significantly as our patient population gets older. Partnering with local brokers is a great way to increase your Medicare Advantage population and keep patients in your health system with a preferred payor. If people have been in your health system as a commercial patient, and now on Medicare Advantage, you have better control on population health levers in your community.
  • There is significant growth in the dual-eligible space where patients have both Medicare and Medicaid. Special needs plans offered by Medicare Advantage payors provide ease of billing and additional revenue opportunities because of coordinated care necessities.
  • Incentive programs, like the one Humana introduced earlier this year, show that payors are willing to pay to make sure health systems are focusing on addressing social determinants of health. Their risk adjustment programs rely on health systems to manage their patient population health programs, so there’s leverage in contracting negotiations for health systems that can already show new and improved care models to treat patients.

 

Reflection

There’s a lot to think about when managing your health system’s performance while also having to develop campaigns and execute them. Strong health systems make strong plans for positive payor outcomes. Whether that’s in negotiations or payor initiatives, be prepared to execute them fully. Below are a few questions that your health system might want to consider:

  • What are you doing to help your health system position their physician engagement?
  • Are you doing enough outreach in the community to build trust and equity in your brand through this pandemic, while promoting care coordination opportunities? 
  • Does your health system’s clinical staff have enough information to drive a strong telehealth program?
  • Who are your strong Medicare Advantage payors? Do you have contract negotiations looming this fall?

 

We’re here to help

As we begin wrapping up Q3, now is the time to reach out to ReviveHealth’s Payor/Provider team. We can help you strategically plan out your Q4 campaigns and negotiations to finish the year stronger than anticipated. Get in touch with ReviveHealth’s Payor/Provider team.

 

 

August 13, 2020
Nothing beats a good old-fashioned conversation.
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