Provider Network Management

Legacy System Challenges and the Need for Improved Provider Network Management

Team Innovaccer
Tue 25 May 2021
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A report by the Centers for Medicare and Medicaid Services (CMS) stated that more than 45% of the locations listed in provider directories are inaccurate. These errors can prevent members from accessing the care they need, leading to poor health outcomes and satisfaction levels.

Discrepancies in the provider directories are only a part of the problem. Provider data is highly complex, and healthcare payers need to integrate and streamline data from multiple sources while ensuring there are no conflicting data points. Most payers validate information manually because they still operate on legacy data systems.

Until recently, payers hadn’t been spending on advancing their IT systems for network management. However, mismanaged provider data can prevent members from accessing the right provider data at the right time, leading to poor provider and member service ratings and overall health plan ratings. Payers recognize the need for a modern data system for efficient provider data management and overall network management.

Why are some payers still holding onto legacy technologies?

CMS recognizes that provider network management is critical. Medicare Advantage organizations are notified of compliance issues and receive warnings when provider directory inaccuracies are identified. Managed care organizations can lose business—and the ability to bid for new business—if they fall short in their provider network initiatives. Provider network management efforts are also imperative to boosting member experience and maintaining payers’ relationships with providers.

Despite the need and the obvious benefits of a sophisticated provider network management system, payers have been slow to let go of legacy systems. Dated IT infrastructure can create connectivity and security issues, but payers continue to hold an “if it ain’t broke, don’t fix it” attitude.

This attitude stems from two factors. The cost of implementing new systems is high, although the returns received over time are sufficient to cover the initial costs. However, most payers have been deferring the decision of making the investment.

Beyond financial factors, payers have hesitated to implement new provider network management systems to avoid disrupting regular workflows. Learning to operate advanced tools and machines may require specialized training for employees, and payers may even need to hire people to work on the new systems.

Payer organizations’ resistance to new technologies is not unjustified. Spending money on new purchasing and implementing new technologies when there is a system that technically is fit to function is not appealing.

Why should payers adopt an advanced provider network management approach?

Waiting for a provider network management system to fail or become obsolete before adopting an advanced system can compromise provider data. And when it happens, payers will not have the liberty to plan and minimize the workflow disruption.

However, it is unlikely to ever happen as most payers continuously tweak their existing legacy applications to keep up with the latest set of requirements.

“Organizations spend a lot of effort continually trying to reengineer legacy systems that are broken,” Health2047 Managing Director of Technology Charles Aunger told HITInfrastrucutre.com .

Fixing legacy systems works in the short term, but patchwork solutions rarely last. IT stakeholders need to continuously update infrastructure to meet requirements, which ultimately costs more than implementing a flexible, modern provider network management system.

The road ahead

Rather than waiting until drastic transformation is required, payers must gradually deploy a holistic network management system to stay ahead of the curve. Patchwork legacy systems risk coming undone at critical times, which can affect provider and member experience. Payers need a modern provider network management system to consolidate provider data from claims, contracts, and other sources through a scalable, flexible platform as well as meet compliance reporting requirements to avoid penalties. Using analytics tools on the unified data, payers can develop and modify their network to meet members’ needs.

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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