Employer-Provider Partnerships Can Transform Healthcare
By Deb Kunferman, Vice President of Provider Contracting & Relations
In the ever-evolving healthcare landscape, one thing remains constant: collaboration breeds innovation. Partnership between employers and providers can increase access to care and create greater value and enduring transformation in the healthcare industry.
To highlight the importance of this partnership, a mix of employers and providers came together at The Alliance’s 2024 Spring Symposium for an insightful panel discussion about how employers and providers can partner to increase access to high-value healthcare.
Representing the employer perspective were Kaley Wilkinson, vice president of enterprise strategy and corporate development at WPS Health Solutions, and Carrie Reif, vice president human resources at Crystal Finishing Systems, Inc. On the provider side, William G. Pickart, CEO of Smart Infusion Therapy Services and Smart Scan Medical Imaging, and Jason Sansone, M.D., president and orthopedic Surgeon at Orthopedic and Spine Centers of Wisconsin lent their expertise.
If you missed the live event or would like to view this panel again, you can watch it on demand here.
Misaligned Incentives
There is an inherent disconnect between providers and health plans because of misaligned incentives. The current fee-for-service model compensates providers for the volume of services they perform. This incentivizes providers to perform more procedures whether other intervention could have been effective. In response, employers are beginning to pull back on what they will cover in their health plans.
Incentives need to be aligned with all stakeholders in the healthcare industry, including providers and healthcare purchasers. One solution to align incentives is to create high-value bundles or shared savings programs. This way, providers do not lose money for not performing additional procedures. This better incentivizes them to do what is best for the patient. With this method, employers and employees also know the cost of the entire episode of care before the procedure is performed so there are no surprises or unplanned costs.
Educate Employees to be Smarter Healthcare Consumers
Just as employers have power as healthcare purchasers, employees and their covered family members have the power to choose where they seek care. Typically, employees do not care about saving money by using preferred-value providers after their deductible is met because they think it does not affect them monetarily. So, it is important for employers to educate their employees to be smarter healthcare consumers. Employers need to make it clear that when employees save the health plan money they benefit because they can have lower (or no) premium increases, lower deductibles, higher wages, and better benefits overall.
Employee engagement and desire to be healthy starts at the top. Employers need to communicate consistently and build healthcare consumerism into the company culture. To do this, employers should prioritize educating employees about what they need to do to save money and maintain or improve their health. This includes communicating frequently, and through a variety of methods. You can read more about how to keep employees engaged year-round here.
Steering Toward High-Value Healthcare
One area for cost savings is orthopedic surgeries like hip and knee surgeries. Employers can save money by paying to send employees to surgical centers of excellence instead of having the surgery performed in a local hospital. By partnering with these providers, employers can negotiate bundled rates, resulting in cost savings.
Another opportunity for savings lies in imaging and infusion services. Steering employees and their families to independent providers for imaging and infusion services can save employers a significant amount of money. For example, in 2022, The Alliance found employer-members would have saved over $2.4 million if their employee populations received all infusion services at Smart Infusion, a high-value, independent provider in The Alliance networks. Self-funded employers can also realize significant savings by guiding their employees to seek care at independent infusion centers instead of hospital-related, outpatient settings.
In addition to offering care at low or $0 copays, the level of savings employers achieve with preferred-value providers means they can afford to offer monetary incentives for employees who receive care from independent providers. This further encourages employees to utilize these providers, saving themselves, their families, and their employers money.
Creating an Onsite or Near Site Clinic
It is important for employers to prioritize investing in creating high-value options for their employees and their families. One effective approach is establishing onsite or near-site clinics. This type of clinic can either be exclusive to an organization or cooperation with nearby organizations.
Onsite or near site clinics can deliver cost-effective services for common healthcare needs such as lab work, generic medications, and preventative and sick visits. By keeping costs low, employers can extend care to employees and their families for a minimal or even $0 copay. This type of clinic can provide more personalized care, fostering trust and familiarity between patients and providers. Onsite and near-site clinics can serve as a convenient, affordable, and knowledgeable healthcare resource for employees and their families.
The success of onsite or near-site clinics, crucial for employers, depends on strong partnerships between employers and providers. It’s best to start modestly and gradually expand services as it becomes possible to work with providers that provide additional services and access the equipment necessary to provide them.
Increasing Value in Healthcare
Healthcare is the one thing that affects everyone. In no other industry do we accept high costs for low quality services or do not know the price before we receive the service. Unfortunately, people are used to poor healthcare, including not knowing the price ahead of time, long wait times, and short, impersonal appointments.
However, healthcare does not have to be this way. As the largest purchasers of healthcare, employers have power to create change. By working together, employers and providers can create a shift in the market and lasting change in the healthcare industry.
The Alliance serves as a voice for self-funded employers who want more control over their healthcare costs. Using our Smarter NetworksSM and sophisticated data mining and analysis, they provide transparent, creative approaches to network and benefit plan design to unlock savings. We are a trusted, collaborative partner for our 425+ employers and their consultants who seek improved access to high-quality healthcare by contracting with a network of 39,000 healthcare providers and doctors across the Midwest.
Reach out to us to learn about the benefits of joining together with other self-funded employers to create more value in healthcare.
Deb Kunferman joined The Alliance in 2013 and now serves as Vice President of Provider Contracting & Relations. Kunferman leads the team responsible for constructing a provider network that brings value to employer healthcare purchasing by providing direction and oversight of provider network development strategies, including maintaining and growing provider partnerships.
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