Many hospitals we work with do not have a strategy to deal with their most profitable payers: employers. These employers purchase insurance or TPA services from major insurers and the insurer masks the real source of the money.
Despite the profitability that these payers offer, hospitals and physicians have historically not interacted with these employers. Developing a strategy for engaging these payers represents a great opportunity to align with your physicians. Based on our experience, the following guidelines will help to build these relationships:
Engage Your Physicians.
Employers provide profitable volume for your physicians as well, so work with your physicians to craft an approach and strategy. The physician may already have relationships with the employers. If not, they can provide insights on care management opportunities and can serve as medical directors for major employers. Make this an early part of the process.
Leverage PCP Expertise.
Employers want to manage costs, at the least lowering the growth rate in expenses. Your hospital does not want to give them lower rates. The employer does not want to control costs by creating bureaucratic hurdles that impede employee access. Better care management becomes the one of two routes to long term success. Utilize your PCPs to lead that effort. Benefit structures can facilitate that, but, ultimately, success will be driven by your physicians.
Understand the Insurers.
The insurer can be your friend or your nemesis. Make them your friend. The data they have can be invaluable as you work to improve the cost performance for a target employer. Their insurance filings, which are readily available in some states, also provide useful information.
Employers know you do not have all the answers, but will initially just be pleased by the opportunity to talk. Ask what problems they see and work with them (and a physician or two) to mine the company’s data to identify opportunities. This may be new and filled with uncertainty. But the best way to learn and begin to better serve this most profitable payer group, is to dive in and start working.
This will require a lot of work, but should be seen as an integral part of your physician alignment strategy, marketing strategy and reform strategy. The alternative is spending all of your time focused on areas where you make no money.
To discuss this idea further, call us.