Provider Network Management

Driving Next-generation Provider Network Management With a Collaborative Approach

Team Innovaccer
Tue 06 April 2021
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Healthcare payers work closely with providers to ensure that their members get appropriate care at the right cost. However, it can be difficult to streamline disconnected provider data, and errors and inaccuracies cause issues for patients, providers, and payers alike.

Accurate, robust provider directory data is key to helping individuals find care. But data points that each year:

  • 20% of physicians change their address and/or phone number
  • 30% change their health plan, hospital or group affiliations
  • 5% have status changes (licenses, sanctions, retirement)

Hospitals, physicians and health plans collectively spend more than $2 billion annually to maintain the integrity of their provider data. Poor provider data management impedes a member’s access to care, creates unexpected medical costs, hinders effective patient-provider matching, and hampers patient satisfaction.

How can payers enhance health plans to drive collaborative, value-oriented patient care? It starts with adopting a provider-centered data approach that connects, aggregates, enriches, and activates data that offers actionable insights to plan and implement efficiency improvements.

Today, network administration is more important than ever, and a high-functioning provider network can improve a payer’s revenue growth, health outcomes, and medical costs.

Provider network management involves bringing cost-effective care to members, driving network design improvements, and creating member-oriented interventions to improve network efficiency. It enables payers to access accurate provider data that's continuously updated and verified.

To capitalize on the shift from volume to value-based care and create better health outcomes, payers have been reimagining their provider relationships to improve care delivery.

The impact of the pandemic on provider network management

The COVID-19 pandemic disrupted the healthcare industry and pushed systems toward value-based care, which required them to form sustainable long-term contracts, account for social factors, and reevaluate healthcare spending. These changes were mainly implemented through contracting, and payers have struggled to manage the evolving attributes and performance measures needed to create more effective value-based contracting terms.

While the shift to value-based care has improved health outcomes, procuring and consolidating data from different sources and systems can be overwhelming for payers. Legacy systems are not equipped to handle the complexities and nuances of value-based contracting, resulting in technological constraints and poor execution of value-based arrangements.

In order to drive individual and network-wide provider performance, payers need to take a comprehensive approach, enable point of care alerts, and expand patient engagement capabilities to improve total cost of care, quality scores, and member health value.

Challenges with building effective provider networks

Increasingly complex value-based care arrangements impact reimbursements and incentive programs, emphasizing the need for sophisticated provider network management.

Payers need a solution that can help them manage and streamline provider relationships, access scalable technologies, and enable fiscal management for optimal outcomes. Let’s look at some of the challenges that payers are facing:

  • Payers manage and store the provider’s data in disjointed systems due to the persistent use of homegrown technology to support provider contracting. This results in irregularities, errors, and higher reworking costs.
  • Users from contracting and credentialing departments work on disparate point solutions, resulting in duplication of data, loss of productivity, and decreased transparency. Synchronizing these solutions can be expensive and introduces the risk of the patchwork coming undone in critical situations.
  • Payers have limited ability to drive payment transformation as they continue to rely on claims data to support value-based contracting models.
  • Payers have limited ability to support provider-centered innovation to drive improved health outcomes.
  • Payers lack standardized data management strategies, and manual provider information management reduces the accuracy of data, making it difficult to reconcile inconsistencies.
  • Payers lack a single source of truth that automates the activation of data across organizations, forcing payers to continuously reprocess data.
  • Payers face vast technology limitations to drive greater provider engagement for specific patient cohorts due to the transactional nature of provider data.
  • Payers are faced with system limitations in proactively measuring provider performance, impacting member outcomes, and collaborating on care delivery.

4 steps to building a comprehensive provider data foundation

  1. Establish a unified provider directory to drive holistic provider network management workflows and outcomes with unified and accurate provider data.
  2. Drive provider engagement, provider performance, and vendor management to encourage payer-provider collaboration and loyalty.
  3. Build a centralized provider network analytics layer to measure performance, align providers tightly, power workflow automation and facilitation, and leverage reporting and dashboarding capabilities.
  4. Enable a centralized, 360-degree view of provider data to track vendor outcomes and appropriately engage vendors to boost provider performance.

The future of provider network management is payer-provider collaboration

Payers need to replace their traditional contracting, credentialing, and configuration point solutions with a next-generation provider network management solution, focusing on network insights to improve performance. This integrated approach drives network design improvements, point of care solutions, and member-oriented interventions to improve network efficiency.

By leveraging Innovaccer’s Provider Network Management Solution, payers can exercise greater control over their network performance through contract and provider directory management, targeted provider interventions, improved network design, network performance insights, transparency on provider performance, and medical cost savings.

They will be able to boost health plan performance, drive collaboration and connectivity among member stakeholders, and improve relationships with providers. Innovaccer’s end-to-end Provider Network Management Solution is comprised of:

  • Centralized provider data and analytics foundations that will enable payers to create a “single source of provider truth” with an integrated and flexible platform for all network management needs, including contracting, credentialing, operations, and communications.
  • A payer command center that brings life cycle interactions together from the provider contracting team’s negotiations through onboarding, educational outreach, service, and appeals.
  • Provider-facing workflows that engage providers and members beyond disjointed communications through multichannel chats and point-of-care insights to drive financial and health improvements.

To learn how to exercise control over your provider network performance with the Innovaccer Health Cloud for payers, get a demo.

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