health plan solutions can help improve patient care, but ... · in health care.3 as health plans...

FEATURE

Health plan solutions can help improve patient care, but will providers adopt them?Collaborating for care delivery can create a superior member and patient experience

Leslie Read, Matthew Kaye, and Natasha Elsner

From the Deloitte Center for Health Solutions

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Introduction

MOST HEALTH PLANS have tradition-ally played a limited role in the provider and patient care experience, but this

is changing rapidly. Increasing medical costs coupled with competition from disruptive players are causing many providers to rethink their care models, sources for data, and insights. These pres-sures are also causing health plans to rethink their growth strategies and the nature of their provider relationships. Health plans’ M&A, partnership, and investment activities are shifting from horizontal to vertical, as they join forces with health care providers, retail pharmacies, and pharmacy benefit managers (PBMs).1 Some employers are ex-perimenting with direct provider contracting and offering em-ployees their own primary care, altogether bypassing traditional insurers.2 New entrants bring a commitment to customer experience, a track record of reducing costs, and unparalleled analytics exper-tise, promising to reinvent the customer experience in health care.3

As health plans consider how to compete for the customer, (i.e., the member, patient, caregiver), collaborating with health care practitioners on the frontlines of delivering care can be a way to create a superior member and patient experience, improve outcomes, and lower costs. But are health care prac-titioners interested in working with health plans and are they willing to adopt the solutions health plans might offer to improve patient care? The

Deloitte Center for Health Solutions conducted a study to help answer this question.

Are physician practices open to solutions from health plans?

Our survey results indicate that they are: Two-thirds of the respondents are open to using solutions from health plans (see figure 1). They also think health plans have an edge, compared to other entities, when it comes to data and insights.

However, health systems are the preferred partner in all five areas (80+ percent) and, in re-spondents’ view, are even better positioned (71 percent) to provide data and insights than health plans (61 percent).

Nonphysician respondents are more open than physicians to working with different entities, including health plans. This may point to admin-istrative demands on nonphysician staff, which are often underserved and could be addressed by health plan solutions (such as patient out-of-pocket cost and eligibility tools).

Collaborating with health care practitioners on the frontlines of delivering care can create superior member and patient experiences, improve outcomes, and lower costs.

Health plans can help providers improve patient care through solutions that use patient- and population-level data and insights.

Health plan solutions can help improve patient care, but will providers adopt them?

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Source: Deloitte analysis.Deloitte Insights | deloitte.com/insights

FIGURE 1

Most health care practitioners are open to solutions from health plansSurvey question: How likely will you be to use the following programs from the following types of organizations? [Reported percentages are for “Definitely will use” and “Probably will use.”]

Cost transparency (n=241) Chronic care management (n=245) Practice performance (n=233)

Care coordination (n=233) Wellness and prevention (n=234)

Hospital or integrated delivery network

Managed services organization (MSO) or independent practice association (IPA)

Health insurance company Pharmaceutical company

Not-for-profit organization, such as a medical society or a coalition of

local providers

Third-party software or technology company

47%

44%37%

43%

50%71%

67%64%

65%

69%

78%

81%72%

79%

79% 77%

78%72%

75%

79%

83%

81%80%

78%

85%86%

86%81%

90%

86%

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IMPLICATIONS

Health plans should partner more closely and more boldly with health systems

Since health care practitioners prefer to work with health systems, health plans should partner closely with health systems in designing and deliv-ering solutions. After all, disruptors are threatening the business models of both health plans and health systems.

Coordinated design of solutions can, at first, revolve around what is known and measurable: gaps in care, and factors in CMS star ratings and the

Healthcare Effectiveness Data and Information Set (HEDIS) scores.

But health plans can and should be bolder in their collaboration with health systems. Imagine network contract negotiations that bring new voices from both sides for cross-functional care delivery design sessions. Such sessions could identify opportunities for partnerships in data and analytics and lead to data and insights sharing provisions in network contracts (i.e., sharing of cost savings when plans and health systems exchange data and insights).

ABOUT THE STUDY

Research objectives

Our goal was to understand how health plans could help support physicians and their staff in delivering better care and assess their openness to receiving this support from health plans. Specifically, we set out to understand:

• Health care practitioners’ interest in and their perceived value of potential solutions offered by health plans

• Barriers to adoption or utilization of health plan solutions and how health plans might overcome them to play a more active role in the patient’s experience of care

Survey design

We conducted the survey using an online panel of health care practitioners in September 2018. Physicians, nurse practitioners, physician assistants, nurses, and practice administrators from 300 US ambulatory primary care and specialty care practices completed the survey. Specialty practices included adult and pediatric endocrinology and adult cardiology.

The survey was designed with expert consultation from Andrew Wiesenthal, MD. With a deep understanding of both care delivery and insurance administration, Dr. Wiesenthal provided guidance to the research team on questionnaire development and interpretation of the findings.

Survey focus

We focused on the five areas in which health plans have existing capabilities or useful data:

• Care coordination: Aligning care across multiple providers or sites.

• Cost transparency: Knowing the costs associated with an individual patient’s care.

• Chronic care management: Caring for patients with complex or chronic conditions.

• Wellness and prevention: Enabling and ensuring that patients stay healthy.

• Practice performance: Meeting individual practices’ financial and quality goals.


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Solutions from health plans could even be white-labeled as coming from the health system to help drive better adoption. With more than half of physicians now employed by health systems,4 the decision to use health plan-provided solutions will most likely reside with hospital and health system administrators.

Furthermore, many of the services health care practitioners find valuable are not commonly available today and cannot be developed using off-the-shelf tools. This means that to get value out of their data and to deliver solutions that seamlessly integrate with physician practice workflows, health plans should partner with new stakeholders, such as electronic health record (EHR) vendors, data integration companies, practice management companies, private or public health information exchanges (HIEs), and public health entities.

What areas of support are most valuable to health care practitioners?

To assess interest in new solutions in each of the five areas, we asked respondents to rate the value of data, tools, and services (collectively referred to as services) that may be part of a comprehensive solu-tion in that area. Almost all respondents (95–100 percent) find the services included in the survey to have at least some value. And they find many ser-vices extremely valuable.

What differentiates the high-rated from low-rated services is their ability to impact care or decision-making at the individual patient level (such as individual patient records) versus at the aggregate or population level (such as practice benchmarking or aggregate utilization reports on all practices’ patients).

CARE COORDINATION The most valuable services relate to care coor-

dination, with multiple services rated “extremely valuable”: individual patients’ lab results, indi-vidual patients’ drug history, individual patients’ hospital or ER records within three days of dis-charge, and sending specialist consult notes to referring physicians on behalf of specialists (see figure 2).

Respondents from primary care practices see significantly greater value in care coordination services than their specialty care counterparts (see figure 4 in Appendix).

COST TRANSPARENCY Our survey data shows physicians and their

staff often face challenges in the area of cost transparency: 37 percent of respondents con-sider this a major challenge for their practice. But cost-transparency solutions are the least common, available to just two in five respondents (43 percent).

When it comes to value, information about patient out-of-pocket costs and eligibility require-ments for drugs and procedures is seen as the most valuable service in this area (see figure 2).

Nonphysician staff who often work closely with patients in managing financial considerations of care see even greater value than physicians in this information (see figure 5 in Appendix).

CHRONIC CARE MANAGEMENT Chronic care management represents a major

challenge to one in three respondents (33 percent). In this area, transportation services to help pa-tients get to medical appointments and medication nonadherence alerts to the practice and patient’s caregiver receive the highest value ratings (see figure 2).

We also found that the perceived value of all services included in this area is significantly higher among nonphy-sicians than among physicians (see figure 6 in Appendix). Chronic care management solutions are com-monly available (with 82 percent of

“[A health plan] can look individually at each patient and their specific needs, which can be very time-consuming if we had to do it ourselves.”

— Practice administrator


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respondents reporting access), but this finding points to opportunities to improve existing offer-ings, especially for nonphysician staff.

WELLNESS AND PREVENTION Automated reminders to patients and care-

givers about medications and recommended medical checkups are the most-valued wellness and prevention services (see figure 2). Nonphysicians, practices with a less favorable payer mix (a payer mix that leans toward Medicaid and uninsured), and primary care practices find greater value in most wellness and prevention services (see figure 7 in Appendix).

PRACTICE PERFORMANCE In this area, performance on gaps in care across

all patients is seen as the most valuable service. Nonphysician staff (45 percent) and practices with a less favorable payer mix (49 percent) see greater value in this information. In general, among the five areas covered, services in the practice perfor-mance category receive the lowest value ratings (see figure 2).

IMPLICATIONS

Design solutions that include multiple servicesSolutions from health plans could include the

most-valued services from the areas of care coor-dination, chronic care management, and wellness and prevention, taking advantage of the data that providers may not be able to easily obtain on their own. Such solutions could include:• Insights derived from multiple data

sources that health care practitioners don’t have access to (enrollment data, health risk assessments, medical and pharmacy claims, disease management and wellness programs, immunization and disease registries).

• Services that enable information sharing and communication among health care prac-titioners involved in patient care. For instance, health plans can work with hospitals to rou-tinely submit admission, discharge, and transfer (ADT) notifications to plans, which in turn can share ADT data with patients’ regular physicians and consulting specialists.5

• Services to optimize prescription drug usage, such as drug history insights, reminders to patients about taking their medications, and nonadherence alerts to patients’ clinicians and caregivers.

Target practitioners who need the most help at the point of care

Initially, solutions can target primary care and practices with high proportions of patients of lower socioeconomic status and/or with multiple chronic conditions. These types of practices see consider-ably greater value in many of the services included in our survey.

Solution developers should keep in mind that patient-level information is most actionable when it is available at the point of care.6

Keep investing in cost-transparency solutions Health plan solutions for cost transparency can

take advantage of their relative strength in 1) data and insights and 2) access to accurate and up-to-date information about the cost of services to the patient and the payer.

To stand out and provide the most value, health plans should consider targeting both physi-cians and nonphysician staff and customizing insights to different users. For instance, physicians could use these insights for ordering tests and pre-scriptions while nonphysicians who tend to be more involved in benefit verification and coordinating patient referrals may see value in additional details (such as network status or deductible).


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FIGURE 2

Services in care coordination are most valuableSurvey question: The following data/insights, tools, and services can be provided to address the issues associated with <area>. Please rate how valuable each of these would be to your practice (extremely valuable, valuable, somewhat valuable, not at all valuable).

Net value rating (extremely valuable and valuable) Extremely valuable

Individual patients’ lab results

Individual patients’ drug history

Individual patient’s hospital or ER record within 3 days of discharge

Sending specialist consult notes to referring physicians on behalf of specialists

Patient out-of-pocket cost and eligibility requirements for specific drugs

Patient out-of-pocket cost and eligibility requirements for procedures

Transportation services for patients to help them get to medical appointments

Alerts to you and the patient’s caregiver when your patient is not refilling medications

Automated reminders to patients and their caregivers about refilling and taking their medications

Automated reminders to patients and their caregivers about recommended medical checkups

Performance on gaps in care (e.g., preventive screening or due medical checkups) across all your patients

CARE COORDINATION

COST TRANSPARENCY

CHRONIC CARE MANAGEMENT

WELLNESS AND PREVENTION

PRACTICE PERFORMANCE

92%64%

90%56%

89%56%

89%53%

88%49%

84%44%

85%44%

87%40%

80%35%

80%43%

76%36%

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What are the barriers to adoption of solutions from health plans?

Health care practitioners see both negatives and positives in working with health plans.

On the positive side, many respondents indicate health plans’ strengths include access to data and the potential to improve care quality. Data and care quality are linked: Health plans’ insights into cost, utilization, and gaps in care, and their focus on pre-vention can help improve care. These strengths can motivate physician practices to work with health plans, especially if they feel that their goals are aligned with health plans’ goals.

Negatives include concerns about health plans’ motivation, intrusion in clinical decision-making, and perceived poor understanding of clinical issues. Respondents also fear a potential negative impact from health plans having too much knowledge about their practice or patients.

The right incentives and evidence of solu-tion effectiveness can convince those disinclined to work with health plans to consider doing so in the future. The most popular incentives from our survey include removing prior authorization re-quirements, granting preferred network status, and

demonstrating that the solution can lower patient costs and improve outcomes (see figure 3).

IMPLICATIONS

Design for an integrated patient and health care practitioner experience

Ideally, any new solutions should optimize both practitioner and patient experience. This calls for health plans and practitioners to cocreate solu-tions by understanding the patient journey, the practitioner experience of enabling access, delivering, and documenting care, and practitioners’ and patients’ pain points.7

To have any chance of adoption, health plans should recognize the many demands on health care practitioners’ time and attention. Thus, new solutions should minimize health care practitioners’ effort, integrating into their existing workflow and systems seamlessly.

Support health care practitioners one patient at a time

Solution developers should recognize health care practitioners’ primary focus: individual patient care. While health plans think of cohorts, popula-tions, and risk, health care practitioners typically have a focus on individual patient needs.8 Therefore, the goal of solutions should be to help health care practitioners improve population health one patient at a time. Over time, health plans can tap into the power of advanced analytics to drive real-time patient-level insights.

Conclusion: Treat physician practices as partners in care

The transition from a transactional vendor-client relationship between health plans and health care practitioners to a true partnership takes time, and the first steps in this journey can be to engage in a dialogue, acknowledge differences, and identify common goals.9

“I believe that health insurers could provide improved tracking and monitoring of patient health outcomes, since they have access to medication use, labs, and screenings.”

— Primary care physician

“Pro: They can easily identify their members and see across-the-board utilization. Con: It results in overly burdensome paperwork, no improvement in outcome, and no actual support to achieving the desired result.”

— Primary care physician


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FIGURE 3

Incentives can play a role in convincing practices to work with health plansSurvey question: Which of the following would persuade you to try this/these programs even if provided by a health insurance company?

Definitely will Probably will

TotalCertain prior authorization requirements are removed in exchange for achieving specific quality goals or metrics

Our practice would receive Tier 1 status in the insurer’s network, ensuring lower patient copays

The program demonstrates that it can lower out-of-pocket costs for patients similar to ours

The program demonstrates that it can improve health outcomes for patients similar to ours

The program demonstrates that it can lower operating costs for practices similar to ours

Our practice would receive credit for quality improvement that can be applied toward government programs

The insurer would provide us with opportunities to grow our practice in innovative ways

The insurer accounts for a large enough proportion of our patient panel

78%

77%

78%

79%

73%

68%

50%

59%

22% 56%

18% 59%

17% 61%

16% 63%

14% 59%

14% 54%

10% 40%

5%54%

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Many health care practitioners are re-ceptive to solutions from health plans that can help improve patient experience and outcomes. Solutions that address unmet needs, complement existing capabili-ties, and provide insights that physician practices cannot get elsewhere could be well-received.

To design and implement such solutions, health plans should view physician practices as partners in care and develop an intimate understanding of practice workflows, the needs of individual physi-cian practices, and the benefits sought by different

users within the practice (physicians, care teams, administrative staff). Solutions designed in this manner can see high adoption and usage, drive value for the users, and help improve patient care quality, outcomes, and cost.

The goal of solutions should be to help health care practitioners improve population health one patient at a time.


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Appendix: Additional data


FIGURE 4

Primary care practices see significantly greater value in several care coordination services

Primary care (n=153) Specialty care (n=80)

Individual patients’ lab results

Individual patients’ drug history

Individual patients' hospital or ER record within

3 days of discharge

61%64%

48%63%62%

44%

Sending specialist consult notes to referring physicians on

behalf of specialists

45%57%

Technological tools that enable communication and collaboration

between providers

39%

53%

Referral pattern reports so you can understand who all the providers

are that care for your patients

36%

41%

Technological tools that enable you and your staff to communi-

cate with patients and caregivers via text, chat, and/or video

31%

34%

Individual patients’ utilization of health care

services over the past 3, 6, and 12 months

26%29%

Aggregate reports of patient utilization over

3, 6, and 12 months

16%

25%


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FIGURE 5

Nonphysician staff see greater value than physicians in several cost-transparency services

Patient out-of-pocket cost and eligibility requirements for specific drugs

Patient out-of-pocket cost and eligibility requirements for procedures

Insurance network status of providers to whom you refer

Tools for patients to help them choose providers for their needs (specialty, home health, etc.)

Quality performance for providers to whom you refer

Individual patient’s progress toward their deductible

Performance on resource use/utilization for providers to whom you refer

Physicians (n=124)

44%

37%

27%

24%

27%

19%

24%

All respondents (n=241)

49%

44%

32%

27%

27%

25%

24%

Nonphysicians (n=117)

55%

51%

36%

29%

28%

31%

23%


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FIGURE 6

Nonphysicians are more likely than physicians to see value in all chronic care services included in the survey

Physicians (n=125) Nonphysicians (n=120)

Alerts to you (or your staff) and the patient’s caregiver (through EHR or text app) when your patient is not refilling medication

Alerts to you (or your staff) and the patient’s caregiver (through EHR or text app) when your patient is due for a checkup

Transportation services for patients to help them get to medical appointments

Support services for patients with childcare needs

Patient data from remote monitoring devices with clinically relevant data interpretation and recommended action steps

Live, personal reminders to patients about taking their medication, such as by phone or video

Live, personal reminders to patients about recommended medical checkups, such as by phone or video

26%

45%

26%

37%

38%

49%

26%

32%

21%

38%

22%

21%

37%

41%


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All respondents

Primary care

Specialty care

23415480

Physicians

Nonphysicians

115119

High Medicaidand uninsured

Low Medicaidand uninsured

55179

26%

27%

24%

18%33%

33%

23%

Automated reminders to patients and their caregivers about refilling and taking their medication

Automated reminders to patients and their caregivers about recommended medical checkups

Tools for patients to find community health and wellness resources

Health coaching services for patients

Information on patient’s nonmedical issues, such as living arrangements, financial stress, employment status, or transportation challenges


FIGURE 7

Nonphysicians, practices with large numbers of Medicaid and uninsured patients, and primary care practices see greater value in wellness and prevention services

44%

49%

36%

39%

50%

64%

39%

29%

32%

24%21%

38%40%

26%

34%

36%

30%26%

41%47%

30%

40%

45%

31%

34%46%

64%

33%


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FIGURE 8

Respondent profile

Total Primary care Specialty care

All respondents 300 199 101

Physician specialty 151 101 50

Primary care (family medicine, internal medicine, general practice, or general pediatrics)

101 101 0

Adult cardiology 33 0 33

Adult endocrinology 16 0 16

Pediatric endocrinology 1 0 1

Nonphysician specialty 149 98 51

Primary care 86 86 0

Adult cardiology 31 0 31

Adult endocrinology 16 0 16

Multispecialty 12 12 0

Pediatric endocrinology 3 0 3

Adult gynecology 1 0 1

Nonphysician role

Nurse practitioner 52 32 20

Physician assistant 26 18 8

Registered nurse 29 17 12

Practice administrator 42 31 11

Source: Deloitte analysis.


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1. Zachary Tracer, “30,000 strong and counting, UnitedHealth gathers a doctor army,” Bloomberg, April 9, 2018; Kenneth R. Gosselin, “CVS-Aetna deal driven by competitive threats in health care,” Hartford Courant, December 3, 2017; Steven Porter, “Cigna’s Express Scripts purchase intensifies PBM market shakeup,” HealthLeaders, March 8, 2018; Reed Abelson, “Merger of Cigna and Express Scripts gets approval from Justice Dept.,” New York Times, September 17, 2018.

2. Les Masterson, “More employers go direct to providers, sidestepping payers,” Healthcare Dive, March 14, 2018.

3. Clayton M. Christensen, Andrew Waldeck, and Rebecca Fogg, “The innovation health care really needs: Help peo-ple manage their own health,” Harvard Business Review, October 30, 2017; Kevin Truong, “How Oscar Health’s CEO charts its path forward in a changing payer landscape,” MedCityNews, October 17, 2018; Chas Roades, “Talking with Oscar, a new kind of health insurer,” Gist Healthcare, August 16, 2018; Zachary Tracer, “Amazon-Berkshire-JPMorgan health venture takes aim at middlemen,” Bloomberg, June 24, 2018; Dylan Scott, “Why Apple, Amazon, and Google are making big health care moves,” Vox, March 6, 2018.

4. Carol K. Kane, Updated data on physician practice arrangements: Physician ownership drops below 50 percent, Ameri-can Medical Association, accessed December 12, 2018.

5. Brooks Daverman et al., “Using hospital admission, discharge, and transfer data to coordinate care: Lessons from Tennessee and Washington,” a webinar by State Health Value Strategies, September 6, 2018.

6. Randolph Gordon, Steve Burrill, and Christine Chang, Volume- to value-based care: Physicians are willing to manage cost but lack data and tools, Deloitte Insights, October 11, 2018.

7. Christina Farr, “Doctors are asking Silicon Valley engineers to spend more time in the hospital before building apps,” CNBC, December 28, 2018.

8. Brian Flanigan, Mark Lockwood, and Christine Chang, Analytics to improve outcomes and reduce cost: Health sys-tems and health plans can work together to jointly win the shift from volume to value, Deloitte, 2017.

9. Ibid.

Endnotes


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LESLIE READ is a principal with Deloitte Consulting LLP, and leader of Deloitte’s Health Plans Customer Transformation solutions. Her client work has focused on helping chief marketing officers, chief strategy officers, chief customer officers, and other health plan and provider sector leaders to develop innovative programs to transform their organizations to be more consumer-centric and drive consumer engagement in health. Read holds an AB from Princeton University and an MBA from the Tuck School of Business at Dartmouth College. She also sits on the Boston Board for Peer Health Exchange. Connect with her on LinkedIn at www.linkedin.com/in/leslie-read-9741052/.

MATTHEW KAYE is a managing director at Monitor Deloitte. He specializes in developing customer-related growth strategies for health care clients, often at the intersection of strategy, innovation, and technology. Earlier in his career, Kaye spent five years at GE, where he held various finance and pricing roles in the United States and Asia. Kaye has an MBA from The Wharton School at the University of Pennsylvania and a BA from Cornell University. Kaye is based in New York. Connect with him on LinkedIn at www.linkedin.com/in/matthewkaye/.

NATASHA ELSNER, Deloitte Services LP, is a research manager with the Deloitte Center for Health Solutions. She has spent more than 10 years in market research serving health care clients. With extensive experience in research methodology and data analysis, Elsner conducts cross-sector research at the center. She holds a master’s degree in survey research and methodology. Connect with her on LinkedIn at www.linkedin.com/in/natasha-usmanova-elsner/.

PROJECT TEAMShane Giuliani and Kristen Schultz helped with survey development and results interpretation, drawing on their industry experience. David Linehan was instrumental in planning the project and coordinating the efforts between different portions of the team. Ryan Carter contributed to research design and project planning. Priyanshi Durbha oversaw survey fielding and initial data analysis. Jackie Barnum and Miriam Wachs provided valuable support throughout the research process.

The authors would like to acknowledge Claudia Douglas, Matt Siegel, David Veroff, and Ralph Judah for their expertise, support, and guidance, and express special thanks to Andy Wiesenthal, who pro-vided expert consultation on questionnaire development and interpretation of the findings.

The authors would also like to thank Lauren Wallace, Samantha Gordon, Ramani Moses, and the many others who contributed their ideas and insights to this project.

About the authors

Acknowledgments


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http://www.linkedin.com/in/leslie-read-9741052/

http://www.linkedin.com/in/matthewkaye/

http://www.linkedin.com/in/natasha-usmanova-elsner/

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Contacts

Leslie ReadPrincipalMonitor Deloitte Deloitte Consulting LLP+1 617 519 [email protected]

Sarah Thomas, MSManaging directorDeloitte Center for Health SolutionsDeloitte Services LP+1 202 220 [email protected]

The source for fresh perspectives in health care: The Deloitte Center for Health Solutions (DCHS), part of Deloitte LLP’s Life Sciences and Health Care practice, looks deeper at the biggest industry issues and pro-vides new thinking around complex challenges. Cutting-edge research and thought-provoking analysis give our clients the insights they need to see things differently and address the changing landscape. To learn more about the DCHS and our research, please visit www.deloitte.com/centerforhealthsolutions.

About the Deloitte Center for Health Solutions

The vast proliferation of consumer innovations seen in areas such as online purchasing, social media, digital marketing, and personalized services is beginning to make its way into health care. With the explosion of digital tools to manage health and the rise of classic “consumerism” in the health care space, this transformation in consumer behavior is driving many health care and life sciences organizations to rethink their consumer relationships and patient engagement strate-gies. For more, visit: www.deloitte.com/us/consumer-health.


http://www.deloitte.com/centerforhealthsolutions

http://www.deloitte.com/us/consumer-health

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health plan solutions can help improve patient care, but ... · in health care.3 as health plans...

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