Tension between providers and managed care organizations is no secret. MCO scrutiny and provider hesitancy around value-based care are among the challenges.
Earlier this month, behavioral health-focused Magellan Health appointed Steven Pratt, MD, as chief medical officer. He sat down with Becker’s for the first time in his new role, sharing his clinical direction for the organization — and how a better relationship with providers is at the crux.
Value-based purchasing, in particular, has been a pain point in payer-provider relationships, he said, but building trust with providers can help ease the transition.
“Historically, there has been friction between managed care companies and providers, and I think we really need to move away from that,” he said. “That means moving away from a role where we’re trying to manage providers into a role where we’re partnering with providers.”
One practical starting point is building a rapport during clinical reviews.
“When I get on the phone with a provider to do a clinical review, my approach is to be very collaborative,” Dr. Pratt said. “I want to engage with the provider, have a clinical discussion about the needs that the person has and make suggestions to try and help improve the treatment plan.” He added he is “trying to establish that as a norm.”
A persistent provider shortage in behavioral health can also be a strain. Yet leveraging technology and collaborative care are some ways Dr. Pratt thinks Magellan can help.
“There are areas in the country that are very underserved, and it’s hard to come up with a solution for that. A single payer probably can’t do a lot to fill in that desert. But what we can do is use technology to help, including things like telehealth, but also the use of self-help tools,” Dr. Pratt said. “One of the things that Magellan works on is collaborative care, which is a means of bringing behavioral health expertise and psychiatric health expertise into primary care settings so that psychiatrist isn’t treating, but consulting to, and that spreads the knowledge base across a wider range of people needing service.”
Another step in alleviating tension: Having payers and MCOs think critically about how they fit into the healthcare ecosystem.
“We’re not the police. We are the supports,” Dr. Pratt said. “To quote a supervisor of mine from a previous role in another managed care company, our job is to manage the interstitial spaces between providers. … What happens between the time they [the patient] leave this person’s office and end up in this next person’s office?”
