The person that buys my goods or services. Easy, right? But, ask that question to somebody working in healthcare, and the answer may vary. To start, let’s think of customers in the healthcare industry as either a patient, a provider (e.g., a doctor) or a health insurance company (also known as “payers”) - a triangle of sorts. On two sides of the triangle, there is a typical customer relationship: 1 patients purchase insurance offered by payers and 2 patients receive care from providers. But what about the third side of the triangle? What is the relationship like between the health insurance company “payer” and their healthcare provider partners? While the relationship between payers and providers can often be transactional, there are a lot of opportunities for payers to improve the relationship with their providers, starting with offering a more customer-like experience.
The healthcare industry is changing; payers and providers are moving to financial arrangements that drive increased collaboration and risk sharing, such as incentivizing providers based on quality, outcomes, and costs (fee for value) vs. the traditional model of simply reimbursing for services rendered (fee for service). To adapt to this shifting relationship, payers and providers need to partner and optimize how they do business with one another, and ultimately deliver the best care to their primary customers – the patients.
So, how can healthcare payers offer a more customer-like experience to their healthcare provider partners?
There are many provider segments and roles. Every interaction with their payer partners is a unique experience. Large integrated health systems may care less about the time it takes to credential and enroll physicians than a stand-alone professional practice that relies on the ability of their new physicians to begin executing services for patients as soon as they are hired. Additionally, a physician may have much more to say about his or her experience with patient care management than the contracting and negotiation process, typically reserved for an office manager or administrator. Understanding the segments and variety of roles within a provider organization and how they are uniquely impacted is the first step to understanding what parts of the provider experience can be explored and optimized.
At the highest level, providers interact with payers when they join a network, deliver care, and get paid. However, there are many day-to-day touchpoints between payers and providers that must be accounted for to understand the holistic experience. Taking an outside-in approach payers should talk to providers about their step-by-step “journey” to help surface pain points and redundant processes that were previously unknown. It is important to not only focus on areas that are perceived to be problematic, but to also focus on being proactive in discovering the points of interaction that have the biggest impact on the relationship with the provider organization. The outside-in approach is conducive for understanding provider pain points (and indirectly patients in some cases!) across the journey and then tailoring and prioritizing solutions accordingly.
Once there is an understanding of the provider’s step-by-step journey for important provider segments and roles, innovation is need to map a plan toward a future state vision. The desired future state provider journey should incorporate feedback from providers and align with the overall corporate strategy. Hosting workshops to innovate on how to improve the experience creates an experience-centric culture and helps surface ideas to fill gaps identified by future state journey design. It’s easy to only focus on internal day-to-day responsibilities, but an experience-centric culture encourages innovation by individuals from an end-to-end provider journey perspective. It is important to remember that a journey is a progression of individual touchpoints, Improving touchpoints without thinking about the holistic journey may not necessarily reduce redundant processes or improve overall satisfaction.
Knowing what and how to measure at each phase of the provider journey is critical to improving the experience overall. Experiential measurements like how satisfied a provider is with onboarding timeliness or the level of effort it takes to submit a claim, help to understand the provider sentiment across a variety of experiences and where to focus efforts. Once initiatives are prioritized to address pain points, operational measures like payment cycle times, can help identify how organizational capabilities are being strengthened. And when paired with experiential measures, they can tell a story of how initiatives are directly and objectively impacting the provider experience. As the industry changes, so will provider expectations. It is imperative that measurement of provider journey phases becomes a recurring capability in order to capture these evolving changes and understand how delivery is impacting the experience over time.
As the amount of collaboration between payers and providers deepens, providers are becoming more like the healthcare payers’ customers every day. Healthcare payers have the opportunity to differentiate themselves by treating them accordingly. Improving quality and affordability of care for patients is paramount to the healthcare industry and improving the payer and healthcare provider relationship is a critical component in achieving that.