Fostering a Strong Provider Network
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A defined provider network may seem limiting to some health plan members. They want the freedom to choose a provider without incurring a substantial out-of-pocket cost for obtaining care outside the network. Health plans must balance this important concern against the benefits of a provider network, including making health care more affordable and improving quality of care through collaboration.
Janice Henry is the associate vice president of Network Management for Johns Hopkins HealthCare (JHHC). She leads the partnership between JHHC and its provider network. As a provider-sponsored health plan, the element of collaboration is more entrenched at JHHC.
“The fact that we can come to the table with the leaders of the Hopkins health care organization, as well as other provider leaders in our network, is a game changer for us,” Janice said. “We have that direct influence from our Hopkins provider community to obtain feedback and have them guide us as to what's working, how best can we engage the provider community at large, and offer perspective on what changes are necessary to improve relations with our members and providers. As a provider-sponsored health plan, we have an opportunity to work together with the Johns Hopkins Health System to transform the delivery of healthcare for our customers.”
With a background in non-provider-sponsored health plans, Janice was eager to join JHHC and leverage the expertise of the Johns Hopkins University School of Medicine and Johns Hopkins Health System, which co-own the organization. With accountability shared between the clinical and management side, payer and provider build on mutual interests in pursuit of improved health outcomes.
“One of the words that I've heard most often is ‘We're part of the family,’” Janice said. “It is a family type business in that we're working toward the same goals and unified in our mission. That's what’s unique and distinguishes us from the traditional health plan.”
Of course, JHHC does not restrict its provider networks exclusively to the Johns Hopkins Health System. That gets back to ensuring choice. But the innate and direct partnership with its parent organizations allows JHHC to strengthen locally before adopting globally.
“You get to start off with family, and with family, they tell you the truth,” Janice said. “They let you know what's working versus what's not working. So when we have that direct feedback, we can transform and transition into making sure that our other providers are getting the same level of support that's necessary for us to succeed.”
As a regional health care organization with a service area covering Maryland and the surrounding states, JHHC has an advantage in efficiently translating that collaboration into practice.
“I view the large national health plans as the large ocean liner,” Janice said. “And the issue with these large ocean liners is they don't really maneuver or pivot very well in adopting new strategies and moving in new directions. But JHHC, because of its size and regional presence, we can pivot more easily and change course to benefit our customers. We know our customers very well and we're part of the community where our customers reside. So it really affords us an opportunity to be more nimble, more agile, and deploy resources needed to make the desired changes.”
One primary objective of the collaboration is to enhance value-based care, an industry-wide transformation. JHHC is in the midst of transitioning from fee-for-service to value-based care, headlined by a pilot program with the Johns Hopkins Health System. Janice said that JHHC wants to be at the forefront of the movement and develop a more robust offering of services for its value-based initiative.
Janice said that value-based arrangements are more meaningful. Whereas fee-for-service depends on volume, the new focus rewards quality and outcomes. The COVID-19 pandemic has accelerated the necessity of this transformation. When patients avoided health care facilities, the drop in utilization illuminated the fallout from that reliance on volume.
“We’re very deliberate when we negotiate our contracts with providers,” Janice said. “We partner with providers to transform the way they conduct their business and manage their patient population. We’re interested in understanding what's happening with our members and how we can work collaboratively to engage members in their care delivery. We want not just to provide financial incentives for our providers but equip them with meaningful data and support to drive quality outcomes".
Another way that payer-provider collaboration can be translated into quality care is through enhanced data and reporting. Timely, relevant reports on member health and gaps in preventive and routine tests and screenings inform providers’ clinical care and support outreach efforts to patients.
“What's critical for us to have meaningful conversations with our provider is presenting them with actionable data,” Janice said. “We want to be able to give them access to information that shows how they’re managing their attributed membership l and where there are opportunities for improvement. It’s important to share reliable data.”
Janice’s Network Management team is one element of the payer-provider collaboration occurring at JHHC. For more insights, check out our previous articles and podcast episodes featuring JHHC’s chief finance officer Dan Chojnowski and chief medical officer Marketa Wills.
Note: Effective July 10, 2023, Johns Hopkins HealthCare is now Johns Hopkins Health Plans.