6 Expectations Employers Have for Provider Care Coordination

Providers are not meeting employees’ needs in certain areas and employers expect more from their provider partners' care coordination strategies, employers expressed in a report compiled by the Council of Accountable Physician Practices (CAPP) and National Alliance of Healthcare Purchaser Coalitions.

Self-insured employers joined providers in five focus groups for a discussion about the major challenges that these stakeholders face in collaborating to provide employees’ healthcare. These discussions were held pre-pandemic from August 2019 to late January 2020.

“Our talks have already identified several common goals to pursue together,” Stephen Parodi, MD, chair of CAPP and associate executive director of The Permanente Medical Group, said in the press release. 

The focus groups highlighted six expectations that employers have of their healthcare systems.

First, employers wanted more affordable care for their employees. A recent Kaiser Family Foundation study confirmed that employers see the current healthcare spending trajectory as unsustainable.

The employer-provider collaborative noted that nearly a quarter of respondents in a Federal Reserve Board survey reported that they skipped some medical care in 2018 and one-fifth stated that they had received surprise bills that same year. Data like this points to the major impact that unaffordable healthcare can have on employee populations.

“The majority of employers in the sessions expressed deep concern and frustration with the health care industry, citing rising costs, inconsistent pricing, and the lack of transparency around cost and quality,” the report stated.

Second, employers were looking for price transparency. Employers in the focus group explained that prices could vary broadly between providers—sometimes increasing 100 percent from one provider to the next for the same service.

“If providers could supply up-front estimates of the out-of-pocket costs for recommended care, surprise billing would cease to be as big of a problem as it is, and employees would be better equipped to manage their personal budgets,” employers argued.

Third, employers wanted to reduce overtreatment. Due to the lack of price transparency, employers could not discern when patients were receiving an excessive amount of certain services, driving up costs.

Fourth, employers sought improvements in patient experience. Employees rely on their employers to coordinate their care, the employers stated. Particularly for complex care regimens, employees who become lost in the medical system often will turn to their employers for answers. 

This trend places employers in the role of both payer and care manager, a role that they are ill-equipped to fulfill. Employers do not have a good perspective of the patient journey. Providers should conduct better care coordination to help patients who are struggling to navigate the healthcare system secure access to care, employer participants said.

Fifth, employers wanted timely access to care for their members. Not only did employers advocate for telehealth, but they also pushed for greater access to care outside of regular business hours.

Telemedicine has its drawbacks, however. Employers noted that it was difficult to get employees to sign up for the third-party services and that, even when they did, the telehealth format could promote disjointed care since employees would be seeing a different doctor every time.

Lastly, employers wanted to see behavioral and physical healthcare become more integrated.

Lack of physical-behavioral healthcare integration had a negative impact on chronic disease management, the employer participants pointed out.

They recommended training primary care practices not only to screen for mental healthcare needs but also to connect those who need support with the appropriate care providers.

Other experts have emphasized the need for widespread adoption of value-based care in order to facilitate physical-behavioral healthcare integration and have recommended substance abuse care treatment as a starting point for integration efforts.

“Primary care must be supported as the hub of integrated service delivery, with an emphasis on delivering preventive care and coordinating services through the various settings and specializations,” Parodi said in the press release.

“Having person-centered metrics versus tracking activity-centered tasks will tell us that we are delivering true quality of care. And we are in agreement that we must change financial incentives. Paying for services piecemeal means higher costs and fragmented care, while payment for value rewards providers for their ability to care for the patient holistically and for innovative approaches like virtual care, telehealth and hospital-in-the-home. We are ready to move beyond ACOs and bundled payments in the journey to value-based care.”