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:
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:
4 steps to building a comprehensive provider data foundation
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:
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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