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 multispecialty networks.
"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
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