Be SMART about managed care
Here’s how to develop your managed care programs
When you are developing a program to offer to managed care companies, you need to put on your thinking CAP, says Mark Deutsch, MBA, director of new business development for Market Share Plus, a health care management and marketing firm in Chesterfield, VA. CAP stands for the three key things consumers want, and therefore payers want to provide: Choice, Accessibility, and Patient Satisfaction.
SMART programs reflect the CAP mentality, he says. Here’s how the programs work:
• Simple.
The programs have to be simple, Deutsch says. Patients should be able to get into the system quickly and easily. Providers, therefore, need to have fast response times and a fast referral process. For example, you might guarantee that you will visit the patient within two hours of getting the referral.
Smaller providers have a great opportunity to simplify the referral process, he says. "Most of the national companies have sophisticated information systems that may require 30 to 40 pieces of information before they can even start a patient on services."
Boil the process down to just the basics, such as name, address, diagnosis, and primary insurer, he says. "What are the bare minimum of pieces of information you need? Do you necessarily need an employer’s phone number in the intake process, or can that wait until you actually talk to the patient?"
Many clinicians believe they need a lot of information up front to make a decision about a patient, but from a marketing perspective, shortening that process while maintaining quality patient care will give you a competitive advantage, Deutsch says.
• Measurable.
Private duty providers have to collect outcomes data, both clinical as well as cost data, he says. Most managed care companies pursue accreditation from the Washington, DC-based National Committee for Quality Assurance (NCQA), the accrediting body for health plans. Because NCQA requires Health Plan Employer Data and Information Set (HEDIS) standardized performance measurements, the managed care companies are looking for providers that already collect this information, too.
Providers will need a tremendous amount of these data during the negotiation process anyway. (For more information about protecting yourself during negotiations with managed care companies, see p. 112.)
But watch out for information overload. "You don’t want to experience what many public speakers call paralysis through analysis’ you have so much information that you constantly analyze it but you never actually move with the marketplace," Deutsch says. "It’s a problem that many providers have. They want so much information and end up letting their competitors pass them by while they are collecting more and more data."
• Accessible.
Providers should be "extremely accessible" geographically to patients via telephone and through on-call processes.
• Responsive.
Be responsive not only to current clients and to the referral process, but also to the market, Deutsch says. "When you see a certain trend happening either in your area or across the country, respond to that rather than ignoring it and conducting business as usual. Don’t be the last on your block to implement change."
For example, Deutsch sees a market for doula services. "Many people misinterpret doula services as part of pregnancy and labor coaching, while it’s really more prenatal care and infant care in the home.
"There’s a tremendous market for it in the larger metropolitan areas," he adds.
• Total commitment to managed care principles.
"That’s what managed care companies really want to see that you believe in managed care and reducing your costs," Deutsch says.
One way to show this is to notify the company if you think a patient no longer needs private duty services, Deutsch says.
Keep track of every time you do this. Then you can say you are not only caring for this patient, but you are saving the company money by discontinuing care for a patient who no longer needs services.
"Managed care companies respect that. You are speaking their language and operating the way they want you to operate. You are showing them that you are watching out for their needs and still taking care of patients effectively."
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