ORLANDO--More physicians are electing to form specialty networks to
contract with health care payers, and professional marketing of these
alliances to health plans is critical to their economic survival,
said Howard Fagin, PhD, of Physician's Health Corporation, an
Atlanta-based company that helps physicians organize single and
"In marketing, the important thing is to understand a health
plan's objectives, then show how your network can help meet those
objectives," Dr. Fagin said at a conference on managed oncology
care organized by International Business Communications.
He advises networks to put together a professional marketing package
describing the network's panel of physicians, how it is organized,
and how it handles a number of important issues. The network should
then prepare a polished oral and visual presentation of the package.
HMOs need data for their HEDIS reports, so they want to work with
networks that can supply the necessary data in an understandable
form. "This means you should include materials in the marketing
package that assure them you know how to analyze data," he added.
Increasingly, networks are being expected to do more of their own
creden-tialing, case management, and precertifi-cation, Dr. Fagin
said, and the marketing package should include an explanation of how
the network handles these issues. A sample of the network's clinical
practice guidelines or pathways should also be included.
Other network functions to consider in the package include
utilization review and management, quality improvement, compliance
with National Committee for Quality Assurance (NCQA) guidelines,
physician reimbursement management, encounter data reporting, network
financial reports, provider profiling, and claims clearinghouse services.
Payers often want networks to act as a clearinghouse for claims, he
said. For example, in oncology, a network might be capitated for
professional services but not for drugs, yet the network might act as
a liaison in paying physicians for the drugs they prescribe.
The availability of encounter data is also important to managed care
plans. "When networks pay their doctors on a capitated basis,
the HMO doesn't know who delivered the services, how often, or to
whom," Dr. Fagin said. "They don't have that information
because they don't have any encounter data, so it's up to the network
to provide the plan with the reports they need in a format they can use."
In summary, a marketing plan must convince the HMO that a network has
control over its physicians, understands managed care, and delivers
care in a consistent, appropriate manner, Dr. Fagin said. He listed
five success indicators that can persuade health plans that a network
is competent and successful (see table below).
Five Indicators of a Successful Physician Specialty Network