• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

Contributor: How Quality, Risk Program Integration Can Improve Provider Engagement and Reduce Administrative Burden


The impact of health plan reporting requirements on provider burden and burnout

As a trained internist and former primary care physician, I have observed first-hand the steep increase in administrative burden and burnout experienced by health care providers. While the goals of the health care system have shifted to focus on the value and outcomes of care delivered rather than the volume of services provided, the systems put in place to drive these changes have become largely unsustainable for physicians and, in some instances, have made patient care less accessible.

We are now at a point where 1 in 5 doctors is planning to leave the practice of medicine in the next 2 years and 1 in 3 is planning to reduce available hours for patient care. This outlook is, rightfully, alarming. But there are practical and innovative opportunities for the health care system to course correct and for patients, providers, health plans, and taxpayers to reap the benefits of value-based care. Health plans have a key role to play in these efforts, as reporting obligations tied to payer-driven quality measurement and risk adjustment programs have contributed significantly to the burnout health care providers face.

Access to care is the foundation for clinical quality and risk score accuracy improvement

Providers are essential partners to health plans in addressing patient care and documentation opportunities that support payer quality metrics and risk score accuracy. These efforts run directly through provider offices, depend on the patient encounter and its documentation, and consequently, impose costs to both the provider and the health plan. For providers, these costs come mainly in the form of reporting and documentation requirements.

The steep burden of paperwork and reporting on physicians is not new. Annals of Internal Medicine published a study in 2016 that concluded outpatient physicians spend only 27% of their time in direct patient care and approximately 50% of their time on administrative tasks. Perhaps more notable is that overall physician perception is low regarding the intended value of these efforts; many physicians do not view the administrative burden tied to health plan reporting requirements to be offset by significant improvements to patient care delivery and outcomes.

Not only are many physician practices dealing with the requirements of multiple health plans across multiple lines of business, they also must interface with separate and often uncoordinated teams within each individual plan. The distinct purpose, goals, and structure of health plan quality and risk programs—and the different areas of expertise required to manage such programs—lend to the siloed organizational structure frequently seen today. This lack of integration, however, often leads to ineffective, disjointed communication from the health plan, a higher level of administrative burden for the provider, and fewer overall direct care hours available for the patient.

Reversing the trend: how technology can ease provider burden and improve care delivery through data and analytics integration

It’s time to ensure that physician obligations tied to quality measurement and risk adjustment reporting are facilitating, not preventing, patient access to care—and it starts at the health plan level with quality and risk program integration.

Program integration is complex. The impetus to integrate a health plan’s quality and risk programs must come from the executive suite and must be supported by the right technologies. A unified analytics platform providing access to a complete, holistic dataset—including underlying clinical member data—is instrumental to enabling this integration and assuring its effectiveness.

Armed with a comprehensive view of each patient’s history and unique care needs, health plans can help physicians improve patient outcomes and reduce administrative burden by doing the following:

  • Coordinating quality and risk program needs to reduce duplicative outreach to providers and patients
  • Sharing analytically identified opportunities that enable providers to address patient care and documentation needs in the same care encounter
  • Streamlining provider messaging to ensure reporting and documentation requirements are clear
  • Sharing data and results with providers that demonstrate the value of quality and risk program efforts

Integration, of course, doesn’t only hold the potential to improve member outcomes and provider experience. It can also have a significant positive impact on health plan operations and costs. Health plans operating with 1 unified analytics solution can reduce their vendor management burden and the program scope and cost of their medical record review programs. In addition, better internal collaboration among quality and risk teams can contribute to a higher level of member satisfaction, resulting in lower turnover among health plan membership.

Ultimately, quality and risk program integration can no longer be a long-term goal that health plans wait to tackle down the line. The reasons for integration are clear, the technologies are available, and the time is now—for the benefit of patients, providers, and the entire health care ecosystem.

Related Videos
Dr Guru Sonpavde
Bevey Miner, executive vice president of health care strategy and policy, Consensus Cloud Solutions
Dr Jeffrey Sippel
christian john lillis
dr kimberly maxfield
Amal Trivedi, MD
Related Content
© 2023 MJH Life Sciences
All rights reserved.