Plan-Provider Collaboration: A Trust-based Model for Better, Cost-effective Care for High-need Membe

By Neil A. Solomon, MD

For high-need, vulnerable populations with complex medical conditions, a coordinated, multidisciplinary approach to care is essential to recognizing and addressing patients’ interconnected clinical, social and behavioral health needs. At MedZed, we believe that the best way to achieve this is to collaborate with health plans as true partners in care.

I recently had the opportunity to host an MHPA webinar together with Marvin J. Gordon, MD, Regional Medical Director at Health Net to share some insights about what that looks like—and how it helps patients. We have worked across the past five years to develop a highly collaborative partnership between our organizations to deliver intensive, coordinated care to the members who need it most.

From the beginning, we built trust into our relationship, through our shared commitment as clinician leaders to a common goal. We designed flexible, member-focused contracts that laid out a framework and expectations for both the plan and providers. We strive to nurture the relationship for the long term and stay agile—with a focus on mutual improvement and success.

We recognize that our organizations each have complementary strengths, and we lean into leveraging each other’s unique expertise and resources. This is especially beneficial when it comes to identifying and recruiting appropriate patients and sharing data. We also prioritize communication: we implemented a host of different communication and collaboration mechanisms between the organizations so that we stay on the same page and in close contact.

In particular, our bi-monthly clinical rounds are an invaluable means to share information and to collaborate. In the webinar, we share a palliative care case study of how we use the clinical rounds to work together to identify the unique, complex—and changing—needs of a patient and help improve their health and well-being. It’s the epitome of how we keep patients at the center and how when we keep our partnership focused on doing the right thing for patients, we all succeed.