UnitedHealthcare Community & State has established a Provider Advisory Council (Council) in each of our markets in support of the National Committee for Quality Assurance (NCQA) standards. These standards help ensure that our strategies and policies align with key state priorities. One way we achieve this is by having in-network providers who work with key priority populations participate on each Council.
Agile councils allow for quick action
Nearly all decisions that UnitedHealthcare makes — whether it be regarding coverage of services, application of evidence-based medical coverage policies or changes to reimbursement methodology — impact how our providers treat patients. To help us gain a more rounded view of how we are serving and meeting the needs of our members, the Council acts as a sounding board and advisor for plan operations, providing feedback on the application of clinical and reimbursement policies.
Provider Advisory Councils meet regularly and also on an as-needed basis, allowing them to be nimble and come together to discuss pressing needs. At the onset of COVID-19, this structure helped us gather provider insights into struggles and necessary adaptions in light of the virus. Getting this information directly from the front line helped us better understand telehealth and personal protective equipment (PPE) needs, as well as community-specific challenges. These conversations helped inform changes to telehealth coverage, financial relief and our supply chains. Since these original conversations, we have had open dialogue with members of Councils to stay on top of these types of emerging needs.
Provider Advisory Council representation aligns with population health priorities
The Council is a broad representation of our network and incorporates providers from different clinical specialties, geographical areas within each state, and organizational sizes, from independent practitioners to large health systems. Membership is re-evaluated periodically to make sure that it is representative of our current network. We also check to make sure that the Councils are receiving meaningful participation and feedback from each council member.
Provider Advisory Councils largely give feedback on new projects, programs and policies aimed to address state priorities. For example, the Ohio Council’s priorities focus on five key populations: child wellness, individuals with behavioral health conditions, women and children, individuals living with chronic conditions and adult wellness. To best align with these priorities, members in our Ohio Council include pediatric specialists, primary care physicians, behavioral health practitioners and nurse practitioners. Because maternal health highly impacts rural areas, the council includes an OB-GYN who works with rural Appalachian populations, and another who works in a more urban setting.
The Ohio Council's primary care physicians range from one who works in a large, academic medical center to another who works in a more rural federally-qualified health center (FQHC). Because specialists often have different reimbursement models and priorities, the council also includes a pulmonologist and a surgeon.
Provider Advisory Councils also take into account the specific needs and viewpoints of innovative programs like Comprehensive Primary Care (CPC), which is a significant practice transformation effort led by the Ohio Department of Medicaid. By having several Council providers who participate in this program, councils can better gather and use insights surrounding these efforts. We also make it a priority to take into account the perspective of providers in FQHCs, which are core to our coverage and network.
Bringing value to our members through Provider Advisory Councils
Our members have different experiences based on their geography and care needs. Having a member’s primary care provider weigh in on coverage policies helps balance costs and benefits to ensure members have sufficient care coverage at an affordable rate.
As we develop and launch new programs to help improve the health of populations, Councils also look to what providers are currently doing in their clinical practices. By placing a wide variety of providers on a Council, there is more opportunity to point out how new programs might conflict with existing policies and processes. It also helps prevent creating a fragmented care system and ensures that new rollouts will complement our overall strategy.
Monitoring physician burnout
Part of the Quadruple Aim, an approach to optimizing health system performance, looks to address workforce satisfaction and reduce physician burnout. As our workforce ages, and fewer students pursue a career in the health field, there are significant concerns surrounding the sustainability of our workforce. Provider Advisory Councils are one way to gauge the stress that providers are experiencing, especially as they serve Medicaid populations. Through direct input from council members, we can better pinpoint what areas of our plan are leading to additional stress for our provider networks.
As we continue to face unprecedented change in the health system moving forward, the input of our Councils will be critical to creating strategies that serve both our members and our provider networks.
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