The importance of patient loyalty to health plans is hard to overlook. Today, when patients have many different options to choose from, retaining them requires careful planning, focus on satisfaction, and proper provider network maintenance. Without a comprehensive approach to patient retention, health plans are likely to lose their audience to the competition.

To make sure that patients don’t try shopping around, payors and providers are opting for a value-based healthcare model. This approach incentivizes healthcare providers to focus on service quality instead of quantity. Meanwhile, this model can help improve operational efficiency and reduce costs.

One of the key elements of value-based patient care for payors is a comprehensive provider management plan. Bringing top providers to the network and ensuring their satisfaction and retention doesn’t just lead to better clinical outcomes. It improves patient satisfaction, ups quality ratings, and provides higher efficiency.

Unfortunately, many payors have outdated business systems that make provider data management harder. This, in turn, interferes with the quality of their value-based healthcare model. To fix that, payors implement provider network management tactics.

What is Provider Network Management?

Provider network management is the process of using technologies to provide support to network members in the following niches:

  •       Credentialing
  •       Onboarding
  •       Enrollments
  •       Privileging
  •       Risk management
  •       Quality improvement

The main goal of provider network management is to provide top-notch healthcare services through improving communications, maintaining healthy relationships, and making sure that providers understand and support the organization’s values and vision.

Health plans utilize provider network management systems that leverage the latest technologies. These technologies can be used to store and categorize care plans, medical claims, lab results, authorization, and other important data. When all of this data is in one place, you can have a better understanding of your provider information and the role they play in your organization’s success.

The Importance of Provider Network Management

When it comes to healthcare services, the main two goals are high treatment quality and patient satisfaction. Provider network management has a direct effect on both. When patients see that they are getting high-quality, useful, and effective service, they are more likely to stay with the provider. When they don’t see these qualities, patients tend to look for other health plans.

Today, provider network management is considered to be the top practice for healthcare organizations. In fact, by 2028, the provider network management market size is likely to reach $6.56 billion. Companies that focus on provider management can see higher revenue and obtain higher star ratings. Health plans with higher ratings can have a much easier time attracting new patients.

Other benefits of top-notch provider network management include:

  •       Compliance – the comprehensive approach to managing providers can ensure compliance with relevant regulations and bylaws. This is especially important during the credentialing process.
  •       Avoiding penalties – without proper network management tactics, it’s easy to make mistakes with data entry and updates. This can result in significant fines and penalties.
  •       Liability – with poor management, you can see an increase in member claims. This, in turn, can hurt your reputation, and reduce your competitive edge.

The growing prevalence of quality care makes provider network management an essential part of health plan operations.

Benefits of Provider Network Management

Value-based healthcare and provider network management go hand in hand. Health plan members are contemplating a high-quality patient-centered approach. Payors are working hard to create a network of qualified providers who can give them a competitive advantage and keep patients happy.

Comprehensive provider network management can help payors take a large step toward value-based healthcare and stand out from the crowd effectively. The key benefits of provider network management for your organization include:

  •       Improved onboarding process
  •       Better revenue management
  •       Streamlined credentialing
  •       Simplified compliance reporting
  •       Improved risk management

With the right tools, it can be possible to automate many aspects of provider network management. Some of the tasks can be outsourced to third-party service providers in order to improve the outcome. For example, many companies choose to outsource credentialing or compliance reporting to companies with large teams of experts with relevant experience.

Challenges of Provider Network Management

Health plans can face a variety of provider network management that can be countered with the right system, tools, and processes. According to the leader in third-party provider network management expert, Andros, the key challenges include:

  •       Patients who see many different providers when getting treatment for one condition (this leads to large volumes of data outside central storage and negatively affects processing, reporting, and analytics)
  •       Lack of clear guidelines about data collection (without a transparent system, it can be hard to understand which data needs to be collected, and how it should be organized and stored).
  •       Providers may feel frustrated about poor data management processors (this could damage the payor-provider relationship and lead to confusion).
  •       Outdated technology makes it impossible to update and access data (this could lead to inaccuracies, delays, and compliance issues)

Overall, ensuring high-quality provider network management requires a diligent approach to creating a working system. This includes implementing the right tools, policies, and strategies. By focusing on enhancing your provider network management today, you are investing in a competitive edge and positive revenue impact.



Categories: Business

Nicolas Desjardins

Hello everyone, I am the main writer for SIND Canada. I've been writing articles for more than 12 years and I like sharing my knowledge. I'm currently writing for many websites and newspapers. I always keep myself very informed to give you the best information. All my years as a computer scientist made me become an incredible researcher. You can contact me on our forum or by email at [email protected].