skip to main content

Insurers are eager to help you help patients improve their health. Learn the surprising ways they can assist you. This is the seventh of seven sections in the Guide to Innovative Practice Models.

It may not always feel like it, but payers have the same goals you do: getting patients healthy, saving money and making sure patients are happy about the care they have received. And payers can help you and your patients in ways you might not realize are possible.

Insurers are moving away from trying to manage every little aspect of care. Instead, they're increasingly focusing on patients who just aren't getting better. Payers need your help, so they're often willing to do what it takes to help you help your patients. As a result, payers may be able to offer you a wide range of assistance.

Ask the insurers you work with if they offer any of the following services:

•  Data mining. The insurers you work with may be willing to share relevant clinical data about your patients with you. You may not know that a patient with a medical condition has been to the emergency room twice in the last month but isn't picking up the prescription for the medication that helps control that condition, for example. If depression is sapping the patient's motivation to address the medical condition, the insurer wants you to know so that you can refine your treatment plan. Similarly, the insurer could let you know when a patient is leaving the hospital so you can follow up with the person and work together to prevent re-admission to inpatient care.

  • Customized technical assistance. Insurers who share clinical data also want to make sure that you know what to do with the information. Call the provider representative at the company and ask for help in interpreting the data or producing reports of your own.
  • Integrated care management. If one of your patients isn't showing up for appointments, it's worth a phone call to the patient's insurer. The insurer may have a team that can help figure out what's going on with the patient and what kind of additional support they might need. Maybe the patient simply needs more reminders about appointments or lacks access to reliable transportation. While your practice may not have the administrative support to provide that kind of assistance, the insurer probably does. Plus, they're motivated to get patients what they need to get better. The insurer may even be able to help with social risk factors such as food insecurity.
  • Help with behavioral health integration. Insurers are pushing behavioral health providers to work more closely with their primary-care counterparts and may be willing to help make that happen. One insurer facilitates integration by offering behavioral health practitioners lists of primary-care practices that might be a good fit with them, for co-location or just referrals.
  • Value-based contracts. Payers may be willing to offer you bonuses for achieving certain goals, such as improving medication adherence or reducing emergency room use. Ask the insurers you work with if they can provide retrospective baseline data and tell you how you compare with other practitioners. Then work together to set and meet new goals.
  • Lunch and learn sessions. Insurers want to ensure that the providers and practice staff their members encounter have the most up-to-date knowledge. Ask the insurers you work with if they can offer lunch-time educational sessions for your practice or the primary-care offices you partner with. The insurer might offer a session to primary-care practices on how to use simple depression screening tools, for example – which not only ensures that problems are caught but could also increase referrals to you. And because the receptionist and other staff are part of the patient experience, be sure to include your entire staff in such sessions.
  • Public education. Stigma is still a powerful force in our society, and insurers may be willing to work with you to combat it. One insurance company, for example, sponsors movie nights at schools. The events feature the 2015 film "Inside Out", an animated look at emotions. Behavioral health professionals attend, too, to answer questions from students and their parents afterward. Another resource to use with both insurers and patients is APA's Psychology Help Center, which offers consumer information on stress, depression, other psychological issues and how psychologists can help .

Working with Payer to Foster Better Care and Demonstrate the Value of Psychology: Karen Dale, RN

The APA Practice Organization gratefully acknowledges the assistance of Jana Martin, PhD; Kevin Ryan, JD; Alan Nessman, JD; Karen Dale, RN; Geoffrey Kanter, PhD; and Vincent J. Bellwoar, PhD, in developing this material

Innovative Practice Models (IPM), formerly referred to as Alternative Practice Models, is now being used to avoid confusion with Alternative Payment Models.

Please note:  Legal issues are complex and highly fact specific and laws vary by jurisdiction. APA Practice Organization staff, consultants and speakers cannot provide legal advice. The information provided in this toolkit is an abbreviated compilation of several workshops and does not constitute legal advice. It should not be used as a substitute for obtaining personal legal advice prior to making personal decisions. Those needing legal advice should contact an experienced attorney licensed in your jurisdiction.

Date created: June 2017