Strengthening the Relationship Between Health Plans and Providers

The relationship between health plans and providers has long been complicated and somewhat fractured. In their dealings, both parties have struggled with various inefficiencies leading to compounding frustration over the years. One of the largest contributing factors to this frustration is how health plans manage referrals into provider offices—a process that traditionally relies on a cumbersome three-way call between the patient, provider, and health plan. Health plans are overwhelmed by the number of calls to schedule, combined with the task of having to coordinate all three parties. Call center agents also have to deal with the frustration of being put on hold for several minutes while they wait for practice staff to be available and are often limited to making calls during working hours, which differ for each provider.

Conversely, providers are overburdened with the time-consuming process of receiving and participating in these calls—all of which are layered on top of their typical daily work load. Some providers may not understand why a health plan is involved with scheduling, pushing back when patients don’t show for an appointment, and leading to further resentment for having to deal with the extra workload.

Every time a call can’t be connected, or every extra minute wasted trying to address provider push back is a missed opportunity to close a gap in care. These frustrations don’t just cause dissatisfaction among health plan and provider staff, it also results in people not getting the care they need.

At MyHealthDirect, we recognize that the success of this relationship is vital for the transition to value-based care. In working with several of our health plan customers, we’ve seen that automated scheduling and analytics can eliminate many of these longstanding pain points, resulting in an improved experience for both parties.

One of our Medicaid plan customers was experiencing many of the issues mentioned above: excessively long call times, and members not booking their follow-ups or showing up for their booked appointment. With our solution, they have since doubled the capacity of their call center by reducing average wait times on the phone by more than half—from 17 minutes to eight minutes. Now, the arduous three-way calls that were a key source of frustration have been replaced by digital referral booking into the providers’ offices. No three-way call is required, and the member has a confirmed, booked appointment in half the time. It’s truly a win-win-win. With this new, streamlined, automated scheduling process, members find it much easier to book a new or follow-up appointment. They are also twice as likely to keep that appointment once it has been scheduled, leaving providers with a dramatic reduction in patient no-shows, which we know is a drain on practice revenue. The providers are also benefiting as staff no longer have to manage incoming calls from the plan’s call center, they simply have to log the bookings in their systems as they come in.

The use of analytics has also vastly improved line of sight into one another’s business, increasing understanding and enhancing overall communication. The health plan receives more valuable and useful insights into providers’ daily operations helping them to better identify areas for improvement, especially when it comes to the member experience and appointment booking process. Moreover, they have real-time analysis of who is and isn’t attending an appointment, contributing to more consistent and targeted follow ups with those who would have previously slipped through the cracks. With predictive analytics, no-shows can be better anticipated and managed well ahead of time. Providers can fill those appointment slots with patients that have a better propensity to show. The ability to actively assist providers rather than blindly request information makes health plans a truer, more collaborative partner. Providers now feel that health plans have their best interest in mind, making it easier to work together without any hesitation or animosity.

At the end of the day, both health plans and providers want to make access to healthcare easier for everyone and reduce gaps in care along the way. When working together, this goal is much easier to achieve, and we are proud to offer a solution that helps to strengthen this powerful relationship. Click on the button below to download the full case study with our Medicaid Health Plan customer.