Three Essentials for Direct-To-Employer Contracting

As healthcare benefit costs continue to worry employers, health systems and employer groups are becoming more sophisticated in their approach to contracting directly. Direct-to-employer contracting deals from health systems allows both entities to both understand and gain more control over how care episodes can be funded. Initiating these discussions and executing them to fruition requires relationship management, strategic involvement of multiple parties, and significant levels of due diligence.

1. First and foremost, get the right people in the room. Layout an understanding of mutual objectives and allow space for both parties to discuss pain points before translating those barriers to concrete action items. Pivotal points of emphasis include A) Realistic expectation setting, B) Aligning the common language and jargon utilized by both parties, C) Recognizing real-world best practices, and D) Discussing the usability of currently available data.
    
2. Don’t reinvent the wheel. Recognize your existing resources. If your organization participates in bundled payment programs, has experience building a clinically integrated network, or boasts a quality-driven culture, these each represent valuable pieces to a direct contracting puzzle. If your organization does not have the technical capability to group episodes of care, discuss actionable clinical practice variation, or provide transparent pricing/cost information to an employer group, this presents a multi-purpose wheel worth inventing.
    
3. Shift the employers’ mindset from ‘benefit providers’ to ‘purchasers’ and prepare your existing data, processes, and people can help them receive a better deal on the superior product you can deliver within your network. Ultimately, their goal is to invest in the health and well-being of their employment base, your goal is to explain how your network can reduce wasteful, inappropriate investments common to the broad delivery of healthcare services in a Fee-For-Service dominant market. Detailing the broad nature of the services you offer can translate with the struggles they likely experience from a consumer perspective. Presenting effective results your organization can provide with robust chronic care case management services, delivering evidence-based care in the acute setting with experience in reviewing inappropriate care (unnecessary imaging, low-value procedures, duplicate services, etc.), and enhancing access to “high value” services in terms of patient outcomes.

Find out more about SHP’s Direct-to-Employer Contracting Services here.