Time for Providers to Control Their Own Destiny

As providers get caught between nagging government regulations, shrinking reimbursement from insurers, and new competition from entrepreneurial startups, the struggle for desirable market share has never been greater. In this carnival of change, hospital and physician leaders have four choices. They can waste time trying to retrace the genesis and evolution that has created this battlefield, they can grind their teeth in frustration, they can fiddle around the fringes and hope for the best, or they can flex their own muscles to control their own destiny.

Controlling one’s own destiny begins with having an impact on how consumers choose their providers, and in that regard there is no simple answer. Those consumers without longstanding relationships often select a health plan first and then choose their provider based on who that plan offers. For those who have a doctor they trust, the reverse is often true – they select a plan based on the provider network. Regardless of how the match was made, that consumer now has connections on many levels: plan, physician and hospital. But on whose doorstep does their loyalty really sit? It is time for providers to own that relationship as never before. And a good place to start is with the Medicare patient, which represents the fastest-growing segment of the American population.

As has been well documented, 10,000 baby boomers age into Medicare on a daily basis. These “new seniors” are being bombarded with messages from competing Medicare Advantage plans that collectively provide coverage for approximately one-third of all Medicare beneficiaries. Their battle for patients is fierce as they all seek to get a slice of this growing, profitable pie. Given the marketing savvy of these plans coupled with the plethora of information being thrown at consumers, it is clear that providers can no longer just assume that patients “will find their way to us.” Today it is more imperative than ever for providers to have a proactive strategy for not just attracting new patients but – perhaps even more important – retaining current ones.

The best way to achieve this is to influence how Medicare beneficiaries select a health plan so as to increase the likelihood that they will select one that allows them to remain with their existing hospital and doctors. The hurdle in this thinking is that regulations by the Centers for Medicare & Medicaid Services prohibit providers from steering patients toward a specific plan. Fortunately, however, there are now independent resources that can support providers in this patient-retention effort.

These resources – not owned or operated by any specific health plan – answer consumer questions regarding coverage options, provide unbiased information on multiple plans, and assist patients in enrolling in a health plan that is accepted by their existing hospital and doctors. Doing so helps assure continuity of care, preserves the trusted relationship built up over time, and allows providers to retain market share they likely worked hard to cultivate.

In addition to providing assistance throughout the enrollment process, these independent services can support ongoing patient communication throughout the year and act as a provider’s safety net if provider/payer negotiations go south at renewal time. If contract termination is eminent, the patient can be immediately   directed toward another plan with whom the provider is contracted, rather than allowing the plan to deliberately assign the member someplace else.

Make no mistake; there is an uneasy equilibrium that exists between providers and the multiple health plans with whom they contract. It is one thing to share patient data in ways that improve health outcomes. It is quite another to share patient loyalty, especially in this era of accountable care where creative new partnerships and alliances emerge daily.

All providers sink or swim based, in great part, on their ability to attract and retain patients for whom they have favorable reimbursement. Helping patients confidently select a health plan that keeps their existing hospital and doctors’ relationships in place is essential toward the achievement of that goal and must therefore become an indispensable part of a provider’s proactive patient communication and population management strategy.

Kerri Lenderman is director of consulting services for MedicareCompareUSA, the nation’s leading independent resource in helping Medicare beneficiaries select a health plan that is accepted by their existing hospital and doctors.  

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