5 min read

Treating Your Provider Network As A Strategic Asset

Treating Your Provider Network As A Strategic Asset

by Lewis Biggers

As someone who has worked within the healthcare industry for 20+ years, I have seen a broad spectrum of healthcare models arrive on (and disappear from) the scene. Those that have been successful share a common trait: They treat their provider network as a strategic asset that drives bottom-line results. 

When well-managed, a strategic provider network does far more than boost membership. It strengthens the health of a system that, in turn, strengthens the health of people of all ages. 

This recognition of the multifaceted value of a strategic provider network lies at the very foundation of our work at Belong Health. While it might be easier to focus myopically on membership numbers, we remain fueled by a passion for data and analytics, for health equity, and for viewing every provider and member engagement through the invaluable lens of behavioral science. 

Such a model is unique not solely because we partner with local and regional health plans on furthering successful D-SNP programs, but also because our partnerships are crafted via specific methodologies that routinely drive success. We center our approach on thoughtful consideration of the entirety of a network — and on getting to know the local flavors, the daily lives and habits, within the communities being served. 

Eager to see how it’s done? Here’s our step-by-step approach to building a high-performing network: 

Step One: Network Assessment 

We start by conducting both qualitative and quantitative evaluations of our local health plan partner. During this assessment, we transparently share referral patterns. We speak candidly about total cost of care. We identify paths that lead to better quality, stronger outcomes, and lower costs. We offer small practices the same powerful data they’d gain from larger health systems — but, then, we go several steps further. 

We lean in to help them tailor a path forward.  

Across all of our work, our team members are deeply invested in the practice of health

Ours is a robust assessment process, through which we determine the appropriate styles of interaction with various physician types — and, in turn, aim to generate the best health plan outcomes available. 

Linking arms with our health plan partners, we conduct a deep dive into diagnostic conditions documentation, with an eye towards addressing Star gap closure and a clear assessment of total cost of care. One of our main objectives, as a result of this thorough process, is to strengthen the medical loss ratio, which often translates to better benefits, stronger membership numbers, and predictable, steady growth for any product type. 

Step Two: Provider Group Segmentation 

In this phase, we segment provider groups, based on behavior and performance, to identify barriers to the highest-quality care. 

Our work is proof that quality need not suffer in the pursuit of cost of care. In fact, our agenda is to center relationships — to make sure every encounter is well documented, and that every person in need is placed on the correct path to care. 

Simultaneously, we’re always eager to sit down and crunch the numbers. Because some practices — in fact, many practices — may not even know their care management is far more expensive than it needs to be. 

Too often, local health plans chase big systems and big health partners while disregarding or underestimating the small ones. Our approach is fundamentally different — we engage the larger practices while going deep with smaller practices to help build strength and capacity where it’s needed most. This allows us to align with smaller practices and physicians to support plan performance. 

In the course of this collaboration, we aid physicians within those systems as they serve people with complex medical needs, maximize their own effectiveness, and join us in shepherding communities around proven patterns of care. 

Put simply, we illustrate patterns of care that exist within a plan’s network today and help them find and adhere to the most efficient path for tomorrow. 

Step Three: Alignment of Incentives 

Across this phase, we align financial incentives with improved performance and with quality metrics. It simply isn’t enough to focus on how much money an individual practitioner will make — equally important is consideration of how much money the network will make as it works to improve its quality of care. Better quality creates more opportunities for practices, but also supports better benefits for plan members.  

Belong Health jumps in to help rebalance that math. By partnering with local community providers and enhancing their capabilities, our work can aid outcomes in... 

  • Closing Star score gaps 
  • Assessing total cost of care 
  • Strengthening medical loss ratio 
  • Securing better benefits, costs, and revenue 

All of which can mean higher membership rates — and happier members — as plans find their way towards steady growth. 

Step Four: Community Organization 

With the help of Accountable Care Organizations (ACO) and Independent Physician Associations (IPA), we create provider communities that are willing to share risk and to coordinate care. Notably, we achieve this by establishing, nurturing, and leveraging a local presence in every community we serve. 

That means engaging with providers on a regular and intimate basis — ensuring they know us by name, by face, and — of course — by our uniquely differentiated value. We believe the key to success in healthcare is relationships — and the key to relationships is, inarguably, trust.  

Step Five: Ongoing Behavior Change  

There’s no substitute for empathetic experts who are willing to go out into the world and meet people where they are. In a world where healthcare is so precious and so personal, connections formed over the phone, or via email, from several states away, just won’t get the job done. 

We create a continuous cycle of engagement — fueled by data-driven insights and action-driven patient impact — in order to drive results. And we do it person-to-person, one relationship at at time. 

We recognize the value of this approach because we are truly in and of the communities we serve, regularly visiting with providers and staying on top of their respective practices. 

It’s all done to infuse every Belong Health relationship with an intimacy and a level of awareness those bigger players don’t even bother to approach. 

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