Marketing to Health Plans
Health plans play a major role in determining the physicians that a patient may see, whichis drastically different from the fee-for-service environment of years ago. While patientsare mostly concerned about the quality of care they receive, health plans are alwayslooking to control costs while providing access to care for their members. If you want tobe accepted into health plan provider networks it is helpful to understand what is requiredof physicians to be properly credentialed and enrolled.
Most health plans are looking for quantifiable evidence of the quality of care you provideto patients. They are also required to meet certain standards for accreditation, such asNCQA. To control costs, health plans may prefer to contract with physicians that are partof a risk unit or other group network model. In addition, plans typically look for boardcertification and other physician accreditation sources as a measure for quality of care. Ifyou have received positive patient satisfaction results, you may choose to share them withhealth plans as well.
If you are entering a market saturated with physicians in your specialty, you may trytaking the time to meet with the medical directors or other health plan representatives tostand out from the crowd and explain your practice. Any presentation should be carefullyplanned, keeping in mind that the main objective is to convey your commitment toprovide efficient, cost-effective care with high levels of patient satisfaction. If you areunable to meet a representative in person, mail the medical director information aboutyour practice and follow up a week or so later with a phone call. This correspondenceshould include:
- Practice name, office location(s) and area served. Also include a mission statement or
- a statement of objectives, including your commitment to quality care, etc.
- Special practice characteristics, such as extended hours, convenient locations, in-
- office ancillary services, and patient education techniques that reduce excessive
- patient visits.
- Physician CVs or resumes.
- Names of all office personnel and their certifications.
- A list of referring physicians in the plan, if you are a specialist.
- Evidence of treatment patterns following published protocols or guidelines, outcome
- studies, or information demonstrating your practice’s quality and efficiency.
- Patient satisfaction survey results and indications of improvement over time.
Once you have signed a provider agreement, be sure to maintain personal contacts withhealth plan representatives and appropriate medical directors to strengthen yourrelationship and help you down the road.