At the recent OPEN MINDS Performance Management Institute conference, presenters from the nation’s top provider organizations and health plans shared their strategies for aligning payment models, leveraging data and fostering provider engagement to drive better outcomes. Below are themes that emerged in key sessions:
Addressing social determinants of health (SDoH) effectively
As payers and providers continue to integrate SDoH initiatives into their care models, one recurring issue emerged: transportation remains a major barrier to care. Even the most well-intended initiatives (e.g., food pantries) can fail if members cannot physically access the service.
Addressing SDoH requires a comprehensive, multi-pronged approach that goes beyond a single intervention. Health plans can support providers by:
- Providing data in a flexible, consumable format that enables providers to act on social risk factors.
- Establishing highly aligned referral networks that connect providers with community-based organizations.
- Equipping care teams with real-time tools to address SDoH challenges at the point of care.
North Carolina’s Healthy Opportunities Pilot is an example of how investing in SDoH can yield measurable reductions in health care utilization and costs. The experimental initiative launched in 2022 with the goal of addressing the non-medical health needs of low-income residents by using Medicaid dollars to offer deliveries of food, rides to doctor’s appointments and other services that are designed to combat the various social, economic and geographic issues that contribute to health disparities. However, scaling these kinds of programs requires thoughtful planning and systemic changes in payment structures.
Change management is a cultural shift, not just a process
Non-profit behavioral health and recovery organizations have demonstrated that transformation is most effective when it is embraced at every level of an organization.
Health plans can support providers by:
- Creating a vision that aligns with evolving care models and reimbursement structures and partnering with providers to deliver and execute.
- Providing technical assistance and resources to help providers transition to new value-based frameworks.
- Encouraging engagement strategies that make change tangible, such as interactive training tools or performance-based incentives.
Presenters showcased principles of change management emphasizing the need to have clearly defined success measures that are clear and transparent to all stakeholders. They highlighted the most critical aspect of leading change is communication. One unique and creative approach was engaging staff via a video challenge. This reinforced key principles while fostering enthusiasm for change. As the health care landscape continues to shift, ensuring provider buy-in will be instrumental to implementing sustainable improvements.
Preparing for policy shifts
A new administration often brings regulatory and funding shifts that directly impact provider networks. Industry experts are predicting major changes in Medicaid, Medicare and managed care contracting, including:
- Increased reliance on Medicare Advantage, with potential constraints on medical loss ratios.
- More risk-based contracts with providers, necessitating strong data capabilities.
- Expanded state-level Medicaid variability, requiring health plans to navigate diverse policy landscapes.
For providers, this will likely mean heightened financial pressures and the need for adaptability as the impact of funding shifts and regulatory changes becomes clearer.
Driving innovation in Medicaid
Fragmentation remains a persistent challenge in Medicaid, particularly for individuals with complex needs. Experts shared an inside look into its innovative complex managed care model, which is focused on member voice and choice, medical and non-medical services, caregiver support and quality improvement. The presenters emphasized the following to strengthen provider partnerships in Medicaid:
- Health plans should align payment models with comprehensive, whole-person care strategies.
- Member-centered approaches should be prioritized, ensuring that services are tailored to individual needs.
- Caregiver support should be embedded into reimbursement structures to recognize the vital role of informal care networks.
“Many behavioral health providers still lack the infrastructure to effectively track and analyze outcomes. Health plans can play a key role by providing tools and incentives that make data collection easier and more actionable.”
Tim McIntyre – Director, Provider Enablement
Data-driven approaches to provider performance
The ability to measure and improve patient outcomes is the foundation of value-based care. Leaders shared how a successful approach to feedback-informed care includes:
- Systematically collecting patient feedback to refine treatment approaches.
- Strengthening the therapeutic alliance, which plays a significant role in clinical outcomes.
- Embedding measurement-based care into provider workflows to drive accountability.
Many behavioral health providers still lack the infrastructure to effectively track and analyze outcomes. Health plans can play a key role by providing tools and incentives that make data collection easier and more actionable.
The OPEN MINDS event offered an excellent opportunity to hear ideas about how health plans can partner with providers to drive better outcomes and can fuel how we can continue to improve access to high-quality, cost-effective behavioral health care.
Tim McIntyre is director of provider enablement at Lucet.
