Industry Insights

Advantasure

The Key to Successful Provider Engagement

There isn’t a single “right” path when it comes to improving member care and medical condition documentation. There are no shortcuts either.

As the market continues to evolve, health plans face mounting pressure to improve quality and keep costs down. However, a properly executed, multifaceted provider engagement program can lay the foundation for risk-score accuracy, Star Ratings and more.

Successful provider engagement programs include at least four key elements:

• Relationships: Consistent communication with physicians reinforces messaging and influences provider behavior. Such high-touch interactions improve provider influence on member compliance and medical record documentation to close gaps in care.
• Flexibility: Meeting providers where they are and blending into existing practices is a great way to maximize program effectiveness. Meanwhile, being flexible with technology and processes further reduces provider abrasion.
• Education: Educational topics can be reinforced via peer-to-peer meetings with medical directors, groups, webinars or handouts. You should be prepared to provide immediate feedback, accept recommendations and track outcomes to identify future educational opportunities.
• Incentives: Design incentive models with program goals and provider populations in mind. The amount should entice providers to participate without negatively impacting return on investment.

Such programs work best when physician practices are assigned dedicated representatives who take the time to understand existing workflows and develop meaningful relationships with providers and other practice personnel.

It’s all about promoting effective physician-patient interactions. For example, representatives might deliver prospective gaps ahead of patient visits to ensure any chronic conditions are captured accurately.

Of course, health plans would be wise not to confuse a high touch with a heavy hand. While
representatives can arm physicians with the information they need to improve medical record documentation, they should not direct physicians to specific conditions.

Done right, provider engagement programs help plans improve member health management, documentation quality, risk score accuracy and Star Ratings, while increasing compliance with CMS guidelines and reducing audit risk.