Is your organization using readily available data to make informed decisions and have actionable conversations?
As the health care industry continues to evolve and favor value-based arrangements, growth strategies like network planning are taking center focus.
We sat down with Alejandro Reti, MD, from Optum to talk about this emerging strategy.
Question: What major trends are you seeing when it comes to growth strategies in today’s market? How do you think COVID-19 has impacted some of these strategies?
Alejandro Reti: For years, we’ve seen a real focus on growth in the market. And with this, I’ve been seeing more and more provider organizations using analytics to guide these growth strategies. They are becoming more data-driven in how they think about provider relationships — informing which providers they want to work with, how and on what services.
I think COVID-19 has put a temporary pause on expansion, however, because of the intense financial strain the pandemic has placed on providers. But I think this financial strain has also led to an acceleration in alignment strategies.
As volumes have generally declined across the board, we’re seeing more health systems employ providers to help them achieve financial sustainability.
Question: Why is network planning as a growth strategy coming to focus now, and what should leaders be doing to achieve success?
AR: I think the focus on network planning in recent years has been the result of organizations maturing in how they think about the value-based market. We want to provide efficient, effective and, in many cases, preventive care so we keep people as healthy as possible.
We do this best by engaging the right providers who are dedicated to delivering such care. Success in network planning and optimization could look different for different organizations, so let’s look at this from two angles: fee-for-service and value-based care.
In a fee-for-service organization, we’re looking for providers that help increase volume productivity. We’re focused on things like where business and profits are coming from, and how to build high-quality referral streams from loyal providers.
But with a value-based care organization, we’re more focused on finding those individual providers that are prudent in the care they deliver. These providers are evidence-based and likely to maintain good communication with primary care offices.
In either case, leaders should also be looking at provider quality measures such as revision rates, volumes and outcomes. Regardless of whether an organization is operating more in fee-for-service or value-based care, analytics can help inform leaders on which providers to build relationships with before their competitors engage them.
Question: Why can’t organizations continue with their current process for selecting providers to engage with?
AR: Fee-for-service organizations that fail to use analytics to identify the right providers could find their competitors will lock up providers they want, just because they had better insight into which providers were ideal to work with first.
On the value-based care side of things, you could end up providing less efficient care when you don’t use analytics to identify your ideal provider partners. For example, if we’re talking about managing coronary artery disease, it’s imperative to manage care longitudinally across the many imaging and procedures that may be needed over time.
But managing and coordinating care across different providers like this is tough. It takes time to find and build relationships with like-minded specialists that will ultimately help you deliver high-quality care with relatively low levels of utilization. Using analytics can help you cut through the noise to quickly find the right providers for you.
Question: What types of analytics and metrics should organizations focus on to optimize their network?
AR: It will all ultimately depend on whether the organization is operating more in a fee-for-service or value-based care world. Regardless of where they fall, many of the data points they need can be derived from claims and are available very broadly at this point.
The information itself can often be challenging to interpret though. This is why many organizations choose to engage outside solutions like Optum Network Planning. It can help with the difficult task of marrying performance measurement with the clinical knowledge and expertise necessary to build new relationships or fix broken ones.
While these data points are useful in identifying good partners initially, I think they’re even more valuable in helping to manage those relationships over time.
Objective data allows you to have in-depth conversations about where everything’s going great, and where there may be issues. These conversations are much less difficult when framed as shared problem solving using credible and transparent data.
Alejandro Reti, MD, MBA
Chief Medical Information Officer