2020 — Employer-Physician Collaborations to Deliver Quality Care

employer and physician torn apart by wooden blocks representing health care insurance

Better Together Health 2020

Exploring Employer-Physician Partnerships to Deliver Quality Care

Over 2019 and 2020, Council of Accountable Physician Practices (CAPP) conducted a series of listening sessions with health care purchasers across the country to understand the context in which employers make health care purchasing decisions, what they want for their employees in terms of health care delivery, and the barriers that undermine a direct, collaborative relationship between the buyers and providers of care.

The results of these listening sessions uncovered a wealth of opportunities for physicians and employers to explore ways to support one another to achieve our shared goal of improving and maintaining the health of workers and all Americans.  Here are some of the findings:

"Why doesn’t the billed rate equal the allowable rate?"

What employer-purchasers want from health care

  • Affordable coverage
  • Simple, transparent financial transactions
  • The right care, not more care
  • A seamless and coordinated patient experience
  • Increased and timely access to specialists
  • Integrated behavioral health
“There is so much variability in how quality is even being measured, we don’t know who is good and bad...”

Why employers struggle with evaluating health care providers

  • Limited discretion to design networks
  • Lack resources and reliable tools to evaluate and compare provider quality
  • Can’t see what’s working, only what’s not
  • Distrust of health plans, consultants, and providers
“If physicians and employers could say, out loud...we’re a part of a system that’s broken, we’re going to explore some fundamental change, then maybe we might be able to get something to happen.”

High-priority areas for physician-employer collaboration

  • Focusing on achieving a coordinated care experience for patients so that an illness is not economically and emotionally devastating, and medical outcomes are optimized
  • Advocating for transparency on price and quality measures
  • Building models of care that integrate behavioral health with medical care
“[The hospital consolidation] is not sustainable anymore...”

Employers’ experience of national health care trends

  • Fee-for-service payment system is problematic, but commercial payers slower to adopt value-based payment models
  • Consolidation of smaller providers into larger groups and health systems, coupled with capital expansion, driving cost increases
  • Rise of specialty service vendors, with mixed results
  • Some innovative employers are trying a range of strategies with mixed results:
  • Centers of excellence
  • High-performing provider networks that demonstrate lower total cost of care and high quality
  • Reference-based pricing strategies
  • Bundled pricing arrangements
  • Narrow networks
  • High-deductible plans
“Where are our dollars going? Right now, we really feel like we don’t have much control over how we are spending them.”

Barriers and constraints to developing employer-provider partnerships

  • Lack of transparency
  • Distrust in providers
  • Lack of quality metrics to evaluate providers
  • Unwillingness to disrupt current physician-employee relationships
  • Lack of internal resources
  • Need for multi-regional solutions
  • Union impacts
  • Contractual constraints
  • Potential employee push-back
  • Market dominance

These and other results of the research will be used to initiate regional dialogues between employers and physician leaders to identify ways in which the two parties might work together to achieve better health outcomes.  These dialogues will take place in virtual roundtable meetings of physicians and employers later in 2020, hosted by local purchasing coalitions.

To foster honest discussion and transparency, attendance at the 2020 roundtables is by invitation-only.  Summaries of the discussions will be released later this year.

July 21, 2020

Hosted by the Dallas-Fort Worth Business Group on Health

July 23, 2020

Hosted by the the Pacific Business Group on Health

August 4, 2020

Hosted by the the MidWest Business Group on Health