Moving from “the data is wrong” to “all data is flawed but still useful”

April 12th, 2017 / By L. Gordon Moore, MD

Value-based purchasing and population health management are supposed to change aspects of the relationship between insurers (health plans) and providers (accountable care organizations, health systems, etc).  New contracts are supposed to align incentives for all involved:  Better care delivery results in reduced unnecessary care delivery and better outcomes at lower cost.

Starting from “we’re all on the same side of the table,” health plans and health systems are interested in engaging with the clinicians to better support the front lines of care delivery to enable the better outcomes.  I hear the question often: “How can I better engage the physicians and health professionals?”  I had an opportunity to explore this issue in a session with a number of health plan executives.

These health plans all have contracts with delivery systems and provider groups that reward improvements in population health management.  While there is variability in the contracts, they all include risk-adjusted total cost of care, quality scores, and metrics that track population health outcomes (potentially preventable hospitalization for example).

The health plans have a considerable amount of data they share.  These data track key variables and can be used to gain insights into patterns of care delivery that could potentially be modified to result in better outcomes.  The executives have experienced difficulty getting past “your data is wrong” to “all data is flawed, but can still be useful.”

Several health plan executives shared their experience moving to a place of greater trust.  Their experiences track stories of others who have moved from low to better trust.  Here are the common elements of those stories:

Demonstrate competence

The health plan staff who share data with the providers have a deep understanding of the data and the underlying methodologies.  When questions arise, they typically have answers at their fingertips and can explain intricacies to the satisfaction of the audience.  This competence came from hard work before they met with the providers – time to delve into the data and work with experts to gain competence in the underlying methodologies.

Be flexible

The health plan staff were well-versed in the tools and able to modify reports to the request of the providers.  If a provider group wanted PMPY instead of PMPM, it was a change they could make.  This flexibility extended to the health plan staff anticipating likely drill-down requests and having that drill-down on hand and ready the moment it was requested in a meeting.

An abundance of transparency

This goes back to the competence and flexibility:  In some case study work we’ve done with providers who talk about the good relationship they have with their health plans, they all mention transparency.  The plan staff are described (by the providers) as willing to share information, great at responding quickly by phone or email to questions, willing to delve into data to better understand something that initially looks weird, and willing to explain the odd findings.

The bottom line is that the staff didn’t necessarily have to know all the answers, but if they consistently demonstrated the qualities above, the providers were more likely to describe a positive relationship and recognize value in data that is never perfect but still useful.

L. Gordon Moore, MD, is senior medical director for Populations and Payment Solutions at 3M Health Information Systems.