Network planning and optimization success

As the health care industry continues to evolve and favor value-based arrangements, growth strategies like network planning are taking center focus for many leaders. 

We recently sat down with Alejandro Reti, MD, of Optum Care^® to talk about this emerging strategy. We wanted to know how leaders can use data and analytics to make informed decisions for their network. Additionally, how can these insights drive actionable conversations with providers to cultivate new or existing relationships or heal broken ones.

Question: What major trends are you seeing when it comes to growth strategies in today’s market? And more specifically, how do you think COVID-19 has impacted some of these strategies?

Alejandro Reti: For years, we’ve seen a real focus on growth in the market. And with this, I’ve been seeing more and more provider organizations using analytics to guide these growth strategies. 

There is more provider behavior data available at the market level than ever before. So we're seeing a real shift in how leaders leverage the information. They are becoming more data-driven in how they think about provider relationships — informing which providers they want to work with, how and on what services. 

The burning question on everyone’s mind is how COVID-19 has impacted growth strategies. I think it’s put a temporary pause on expansion because of the intense financial strain the pandemic has placed on providers.

However, I think this financial strain has also led to an acceleration in alignment strategies. 

When COVID-19 first started, we saw substantial drops in volume across providers, some 50% or more depending on the type of care offered. Once things stabilized a bit, we saw volumes get back around 85%. But only in select settings did we see things get back to 100% or more, which is what one would expect after a period of deferred care. 

This has obviously put a lot of stress on independent doctors, smaller medical groups and even some larger medical groups. We’re seeing more health systems employ providers to help them achieve financial sustainability. I think this ebb and flow will continue for the next six months or so as we surge up and down again over the winter and spring. 

Question: There’s a lot of buzz in the industry around network planning and network optimization as a growth strategy. Why is this strategy coming to focus now, and what should leaders be doing to achieve success?

AR: I think the focus on network planning in recent years has been the result of organizations really maturing in how they think about the value-based market. Years ago, when we would see increases in disease prevalence across a population, we would also see a general increase across a wide range of procedures. But today, there are real pressures against doing this.

We want to provide efficient, effective and, in many cases, preventive care so we keep people as healthy as possible. We do this best by engaging the right providers who are dedicated to delivering such care. For example, we can use a combination of outcome and complication data along with “clean cath” rate statistics to distinguish interventional cardiologists with good outcomes who also avoid unnecessary catheterizations. The data points are there if we make the effort to look at them.

Success in network planning and optimization could look different for different organizations, so let’s look at this from two angles: fee-for-service and value-based care. In a fee-for-service organization, we’re going to be focusing most on how to find providers that will help increase volume productivity. We look at things like where business is coming from, where profits are coming from and how to build high-quality referral streams from loyal providers. 

But with a value-based care organization, we’re more focused on finding those individual providers that are prudent in the care they deliver. These providers are evidence-based and likely to maintain good communication with primary care offices.

In either case, leaders should also be looking at provider quality measures such as revision rates, volumes and outcomes. Regardless of whether an organization is operating more in fee-for-service or value-based care, analytics can help inform leaders on which providers to build relationships with before their competitors engage them.

Question: Why can’t organizations continue with their current process for selecting providers to engage with? What are they missing out on by not using analytics?

AR: Fee-for-service organizations that fail to use analytics to identify the right providers could find their competitors will lock up providers they want, just because they had better insight.

For example, a competitor in your market may have information on the providers they’re working with, you’re working with and a third group across town is working with. In this case, they could build relationships with those providers and potentially take volume away from you.

On the value-based care side of things, you could end up providing less efficient care when you don’t use analytics to identify your ideal provider partners. For example, if we’re talking about managing coronary artery disease, it’s imperative to manage care longitudinally across the many imaging and procedures that may be needed over time. 

But managing and coordinating care across different providers like this is tough. It takes time to find and build relationships with like-minded specialists that will ultimately help you deliver high-quality care with relatively low levels of utilization.

Using analytics can help you cut through the noise to quickly find the right providers for you. It is easier to achieve good results by working with people who are naturally like-minded than to try and convince dissimilar providers to change their practice patterns. 

Question: What types of analytics and metrics should organizations focus on to optimize their network? Where do they find this data?

AR: It will all ultimately depend on whether the organization is operating more in a fee-for-service world or a value-based care world. As I mentioned earlier, fee-for-service organizations will be more focused on volume metrics and value-based care organizations will focus more on a range of metrics from efficiency to outcomes to relationships. 

Much of these data points can be derived from claims and are available very broadly at this point. The information itself can often be challenging to interpret though. Many people who could be doing more of this are scared off by feeling like they don’t have the clinical and analytic expertise in-house.

This is why many organizations choose to engage outside solutions like Optum Network Planning. It can help you with the difficult task of marrying performance measurement with the clinical knowledge and expertise necessary to build new relationships or fix broken ones. 

While these data points are useful in identifying good partners initially, I think they’re even more valuable in helping to manage those relationships over time. Objective data allows you to have in-depth conversations about where everything’s going great, and where there may be issues. From there, it lets you talk about the root causes and work on things together. 

These conversations are much less difficult when framed as shared problem solving using credible and transparent data. The prospect of busy waiting rooms and strong referral relationships is often incentive enough to devote time to performance improvement activities with referring providers.

About the author