In the highly competitive space of health plans, the importance of a well-managed provider network can’t be overlooked. Without a robust approach to the provider network management, it’s easy to lose patients, incur unexpected expenses, encounter issues with providers, and much more.
Health plans can outsource different elements of the provider network to third-party service providers. Even if you plan to arrange management in-house, implementing the right steps is key to achieving success with both patients and healthcare providers.
To begin working toward improving provider network management, you need to focus on making it easier for providers to apply to and join your network. This can include automating some of the application, credentialing, and enrollment processes. It can be hard to find one solution that improves all three processes. However, with the right approach to integration and outsourcing, it’s possible to achieve excellent results and stay ahead of the competition.
Let’s take a closer look at the main stages of provider network management that can help your health plan stay ahead of the game.
Elements of Provider Network Management
To ensure smooth provider network management, you have to streamline each of its main elements, including.
Credentialing is the process of checking the healthcare provider’s credentials and arranging their affiliation with the health plan. When credentialing is completed, the provider can join the network and get reimbursed for their work.
This part of provider network management is usually complex and time-consuming. In some cases, it can take up to a year. Meanwhile, credentialing has an expiration date. The majority of providers have to be re-credentialed every three years.
Credentialing involves long hours of manual labor and a big volume of paperwork. Many organizations prefer outsourcing credentialing to third-party service providers. You can learn more about it here.
Once credentialing is completed, the provider is enrolled. When this happens, the payor has to continuously monitor the need for re-credentialing. Missed re-credentialing process can lead to reimbursement issues. That’s why it’s an essential part of successful provider network management.
A provider contract is a contract between a health plan and a healthcare provider. When the healthcare provider joins the network, they need to sign a contract that lays out the conditions of this partnership. Ensuring the quality and efficiency of this contract is part of successful provider network management. For those unfamiliar with the intricacies of this area, a comprehensive contract management overview can provide deeper insights into best practices and challenges.
The key to ensuring a fruitful relationship between the provider and the health plan is creating a detailed contract that covers all the aspects of the partnership. The contract should consider the needs of both parties and provide information about solving conflicts if any arise.
A well-designed contract encourages the provider to arrange high-quality care for the patients, thus improving the health plan’s bottom line.
The next vital element of provider network management is maintaining a high-quality relationship with the providers. The goal is to retain qualified providers after their contract is up. Since you invest a significant amount of time and effort in attracting providers to your plan, you have to work on retention.
Working on the provider relationship streamlines productivity, improves loyalty, and increases both provider and patient satisfaction. It involves communicating with providers, gathering their feedback, and helping them achieve success with the network.
Health plans with hundreds of providers accumulate large amounts of data. Keeping this data in order is integral to successful provider network management. From credentialing to performance tracking, the right tools and technologies can help streamline the process while saving time and money.
Whether you are working on provider management on your own or outsourcing it to another party, you need data management solutions. They can vary from simple cloud data storage to complex database infrastructures. Depending on the health plan’s needs and resources, it’s imperative to automate as many data collection and processing tasks as possible.
Once you have the right tools, you can analyze the data to make effective decisions about network operations.
Provider Network Management Strategy
To achieve success with your provider network, you have to design an effective provider management strategy. It should include all the abovementioned elements as well as tactics that keep them in top shape.
Here are some best practices to consider when building this strategy include:
- Leverage automation – Automating as many management tasks as possible can help save you time and money while increasing provider satisfaction and decreasing errors. For proper automation, you need to explore provider network management solutions and technologies.
- Consider outsourcing – provider network management is a set of complex measures that demand numerous resources. If you don’t have these resources, including time and manpower, you may want to outsource the process to a third-party service provider.
- Monitor re-credentialing – missed re-credentialing comes with a danger of unpaid claims and extra expenses for all parties involved. Set up a re-credentialing schedule for all of your providers. It should include timely reminders.
- Build loyalty – implementing retention and loyalty-building tactics can keep experienced providers with your health plans and prevent issues with expired contracts.
Overall, with the right approach to the provider network management, you can ensure smooth network operation, provider loyalty, and patient satisfaction. Today, focus on the patient is integral to the success of any health plan. If you integrate top provider network management tactics, you can offer the patients the care they deserve while improving the health plan’s bottom line.