So how do Managed Care relationships become adversarial?
You may say a clue lies in the very name “managed care.” The struggle to manage the cost of patient care by a payer often creates tension as it may infringe upon a healthcare provider’s payments, services, or operations. The word “Denial” alone evokes tense emotions.
Conversely, a provider’s inability to follow agreed-upon policies or procedures often creates angst for a payer.
However, I would argue it is our approach towards how we manage healthcare that is at the source of this adversarial tension – a process that is deeply rooted in how people approach problem-solving.
As humans, we’re all hard-wired to problem-solve by either resolving deficiencies or improving upon existing strengths. That said, our tendencies urge us to label deficiencies as problems first, and this dictates our focus and efforts. In short, the “If it isn’t broke… don’t fix it” mentality too often leads us away from attempting to improve upon strengths and drives us towards resolving flaws.
So how does a problem-solving mindset that focuses on defects cause tension in a payer/provider relationship?
In the following five ways:
- Individuals frequently choose to identify issues coming from outside their organization.
- Complex healthcare data can lead us to misidentify issues.
- Ill-informed conclusions can produce inappropriate blame on an outside party.
- Preemptive remedies are often viewed as unjust by outside parties.
- The outside party employs defensive measures, which further stresses the relationship.
All of these factors can conspire to make payer/provider relationships more fraught — a situation that weakens both sides and leads to competitive disadvantages.
Why is it essential to avoid adversarial managed care relationships?
Two reasons: Customer relationships and lost business opportunities.
Payers and providers share customers: patients/members, employers, providers, government entities, as well as each other. Adversarial relationships often have unintended consequences among these customers.
Additionally, preemptive or defensive reprisals only serve to divide payers and providers, a scenario that may preclude valuable partnership opportunities.
How do I look past tactical retaliation and move towards strategies that embrace alignment?
As humans, we’re often predisposed toward defensiveness. If a problem occurs — and we feel as if we aren’t to blame — it’s natural to want to point the finger at others.
However, payers and providers must rise above these tendencies. Assigning blame — even if justified — may feel like the right move at the moment, but ultimately it undermines your relationships.
Instead, it’s imperative that payers and providers work towards solutions that build alignment.
To get started, I suggest taking the following steps:
- Begin with qualified data and an operations assessment.
- Develop meaningful Key Performance Indicators.
- Implement powerful Business Intelligence dashboards and reporting.
- Identify mutual alliances (What do you both do well? What do you both wish to grow or reduce?)
- Create opportunities to celebrate joint achievements.
- Develop a unified long-term enterprise strategy around shared customers.
The Takeaway
Long-term managed care relationships are like any other relationship — they’re only healthy when each party’s objectives are aligned. The key is to shift your organizational problem-solving strategy towards growing your alignments and away from reprisal!
Pay for Performance, Inc. provides managed care assessments conjoined with cutting edge, web-based BI and AI analytics and dashboard reporting that analyzes managed care financial and operational data to facilitate long-term payer/provider strategies.
We have the necessary tools and expertise to help ensure your managed care relationships remain healthy, productive, and profitable.
To schedule your complimentary consult, please contact Pay For Performance, Inc. at 561-501-1747.