Greater Newport Physicians
"You have to really pay close attention to the data so that you can identify where the cost drivers are and, from a relationship basis, make sure you pick the right partner. This is a very collaborative effort. You need a hospital that is all-in and committed and a health plan that sees providers as partners and not adversaries. In order to be successful, you need a long-term commitment. There's nothing we're going to learn that we can't apply to all our contracts. The other partners in this relationship are the employees and the employer. The goal is to show employers that we're managing costs in an effective manner, so we can afford to offer next year's premiums with as close to a zero cost trend as possible. The continuity that we've always provided will benefit patients, but in addition, we're hoping to have a positive impact on employers."
"Providers must push for common terms. That means standards around performance metrics, clinical quality and service criteria, managing the scope of the bundle, exceptions, to what degree it depends on other providers, and finally, cash flow. When do you get paid, how much is withheld, is there downside risk? How predictable is the outcome? And then you have to take ownership of it. It's like quality. The tendency is to react to all external requirements, but ideally you want to have your own definition of quality. As you structure a deal, what are your strengths, the interventions you can bring to bear? Spend the time to come forward with a unified approach."
This article appears in the June 2012 issue of HealthLeaders magazine.