Provider retention is a critical issue for health plans and service delivery networks because quality clinicians are a health plans’ most valuable resource. Retention is particularly important in Medicaid managed care, where low reimbursement rates make recruiting and retaining providers very challenging. Research indicates that there are significant costs associated with losing a network physician. A Colorado Permanente Medical Group study showed that patients whose primary care physician had left the medical group had more hospital admissions, emergency room and specialty visits, and laboratory and x-ray tests (Magrid et al., 2001). Dissatisfaction with care may also lead to higher rates of patient disenrollment.
The Association for Community Affiliated Plans, which represents 18 Medicaid-focused health plans and one integrated service delivery network across 11 states, conducted a comprehensive study of four of its member health plans in 2004 to assess the actions and policies that may inhibit adequate provider recruitment and retention. The top four challenges for recruitment and retention reported by plan executives were: 1) low payment rates; 2) clinicians’ preference for private patients; 3) scarcity of providers, particularly in rural regions; and 4) frustration with referral and pre-authorization processes (The Commonwealth Fund, 2005). The health plans emphasized the importance of two key modes of retention—sustaining relationships with providers through regular meaningful communication and keeping up to date with technology offerings to ease administrative burden.
Health plan leaders achieved the greatest success in improving provider relations in the following five areas:
Payment practices, payment incentives, and financial assistance—providing prompt payment for care or offering incentives for high-quality care
Utilization management practices—updating referral processes, improving authorization practices, improvements to customer service
Communications and provider outreach practices—conducting site visits and engaging in frequent written communication, holding provider recognition events, and updating provider outreach processes
Practices to simplify administrative burdens—includes simplifying the eligibility verification process, the credentialing process, and encounter data submission process
Enabling service practices—health plans may provide certain services to ease burden on provider. Services may include transportation services, child care, interpreter services, and providing phone service to facilitate contact between patient and care manager
Kaiser Permanente, a national leader in provider retention, offered a similar set of best practices centered on enculturation and mentoring, as well as demonstrating strong leadership qualities such as setting expectations, providing feedback, providing recognition, and active listening (King and Speckart, 2006).