In many geographic markets, a comparative analysis of the provider directories shows that a large percentage of physicians participate in all the major health plans. As employers face double-digit premium increases in any markets, they now have the leverage to negotiate rates. The health plan that is viewed as more than a necessary evil by its physicians has the greatest opportunity to thrive. Health plans, providers, and patients need to define their expectations, communicate openly about met and unmet needs, and utilize the tools and spirit of continuous quality improvement activities to advance their relationships and interactions. Health plans can help physicians and their staffs to better understand overall trends in their practices by sharing results of patient satisfaction surveys and disenrollment studies.
Plans also can provide tools that help physician practices to manage and meet patient expectations.
It follows that physicians are likely to grow in loyalty to plans that help them better help their patients. Physician loyalty, in turn, can translate long-term into a competitive advantage for the health plan. William Schlag is a health care consultant based in Scituate, Massachusetts. He has more than 20 years of health plan operations and leadership experience as former CEO of the third largest HMO in Massachusetts. He also served as vice president of marketing for Harvard Pilgrim Health Care, a 1.5 million member HMO in New England.