Last month’s blog post touched upon the importance of coordinated patient engagement efforts under a payer-provider convergence model. As we all know, this isn’t going to be an easy accomplishment, primarily due to the fact that payers and providers traditionally engage with members and patients for different reasons and in different ways.
One potential solution involves a lot of strategy meetings, workflow charts, and negotiations about who will be responsible for what (including paying for the unified engagement solution). While this isn’t impossible – done right, each entity can leverage the other’s strengths – it requires substantial legwork.
There’s another possibility: Outsourcing. More specifically, outsourcing engagement to employers. Though there are some caveats – we’ll get to those – there are also several reasons this just might work.
- Payers strive to cut costs, while providers aim for better care quality and patient outcomes. In many cases, these parallel goals conflict. Employers, on the other hand, are aligned in their wish to accomplish both.
- An engagement solution offered and paid for by the employer, which has a clear incentive to reduce care costs and improve outcomes, solves the thorny issue of which entity will provide access to the solution – an issue that often leaves payers and providers engaging with the same patient at the same time – often with confusing results.
- Since employers see employees every workday, as opposed to a handful of times per year, they can offer many more touchpoints than payers and providers. This presents an opportunity for basic outreach – think wellness-themed fliers in the break room or cafeteria – as well as more comprehensive initiatives such as health coaching, onsite health clinics, or even direct primary care.
- Employers can take steps that directly and immediately benefit employees’ mental health and well-being, whether by allowing telecommuting to reduce stress from rush-hour commutes, mandate breaks throughout the day, or tacke toxic workplace relationships head-on. The best that payers and providers can do is recommend that these steps are taken.
- Employers can establish mutually beneficial relationships with community organizations that promote health, wellness, and lifestyle change. The obvious example is the gym membership discount that’s common among wellness programs; other possible partners include the YMCA that hosts the Diabetes Prevention Program (DPP), the local farmer’s market, or the running / fitness clubs in the neighborhoods where employees live (especially underserved areas where outdoor exercise options are few and far between).
Yes, there are a few reasons for concern, but employers can take careful steps to address them.
- Beware the fine line between voluntary and “voluntary” participation in employer wellness programs, with the latter imposing hefty premium increases for non-participants; there’s an even slipperier slope for non-participation in the DPP or another condition / lifestyle management program that could save an employer thousands of dollars in healthcare costs per person per year. Design programs to reward rather than punish.
- Be careful that employer-led engagement does not take on the impersonal tone of human capital management, focused merely on dollars and cents. This shifts the emphasis away from the benefits of improved outcomes for all parties – patients who are healthier, employers that boost productivity, payers that improve their medical-loss ratio, and providers that achieve higher quality.
- Providers and payers will be reluctant to cede some control over the engagement process, especially when they see engagement as a core competency. Employers should tout their close connections to employees, as well as the non-clinical data they have collected about them, as a key differentiator of their engagement efforts.
- Ensure that employer efforts do not duplicate the work that payers and providers already do, to varying degrees of success. Work with payers and providers to identify gaps in their existing engagement efforts, whether it’s initial outreach, ongoing participation, or follow-up once a particular program has been completed.
The key to overcoming those concerns – as with many of the operational, tactical, and technological challenges of payer-provider convergence – is understanding that convergence and value-based care take a village. Employers aren’t adversaries in a competition for patients’ attention; they are, increasingly, willing partners in healthcare’s mission to improve quality and outcomes while cutting costs.
- Iron Mountain is creating a high-performance network with incentives for employees and their beneficiaries to seek treatment within that network, as well as incentives for physicians within those networks to provide high-quality care to those patients. (Our forthcoming Meet the Speakers interview with Scott Kirchner, Iron Mountain’s director of benefits strategy, will explore this program in more depth.)
- Some employers are reframing the “company doctor” concept by establishing direct partnerships with hospitals, which benefit from the addition of commercially insured patients to their network. Boeing, for example, has contracted directly with providers in several markets, including Seattle, St. Louis, and Southern California. These partnerships can be a lifeline for community hospitals who all too often lose business to larger academic or urban hospitals.
- Nearly all large employers plan to offer insurance coverage of telehealth in 2018, and more than half will offer onsite or near-site health centers, according to the National Business Group on Health. Together, these show a growing willingness to promote access to more convenient care, which allows patients to address their low-acuity care needs – and get back to work – before the situation becomes high-acuity or high-risk.
- Employers are bullish adopters of condition management programs, both as a means of healthcare cost control and as a way to improve patient / employee outcomes.
Chilmark’s Convergence conference will discuss how employers such as Iron Mountain have been a willing partner, taking the lead to reframe the discussion about health insurance and care delivery before market pressures or regulations force their hand. Join us Oct. 4-6 in Boston to learn more.
