Building a top-tier provider network is critical to delivering high-quality healthcare services. Health plans must optimize their provider networks using data analytics and networking research.
It involves understanding utilization patterns, tracking referral patterns, and assessing bundle performance. These insights help identify and recruit providers who align with your network objectives.
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Identify the Right Providers
A health plan’s provider network is a complex ecosystem often underestimated in its importance. Provider Network Management (PNM) includes:
- Recruiting and onboarding healthcare providers.
- Credentialing them for quality assurance.
- Negotiating contracts.
- Overseeing performance expectations.
Provider network optimization can boost member satisfaction and overall cost efficiency for health payers by ensuring access to adequate care and quality services. Inadequate networks result in members seeking out-of-network care, which can be costly for the health payer and the member.
Using data analytics and network research, top-performing payors can identify gaps in coverage. They use this information to improve marketability, bolster member satisfaction, and create high-performing provider networks. It can increase revenue, improve overall health outcomes, and strengthen relationships between health plans and providers.
Engage Your Providers
When creating a top-tier provider network, the right strategy for engagement is crucial. However, getting physicians on board and invested in health system goals is challenging, even though healthcare leaders often assume it will be.
A consistent approach to physician engagement can make a massive difference in outcomes, including member retention, risk-score accuracy, and star ratings. A vital element of the right strategy is providing providers with the tools and information to understand how their actions impact performance metrics. For instance, by tracking and analyzing referral patterns, you can encourage primary care physicians to refer members to high-value specialists and sites of care. It can save significant costs by reducing out-of-network utilization.
Incentives for High Performance
As healthcare costs continue to rise, payors must innovate to reduce expenses. One tool that has proven to be effective in creating value networks. These networks allow members to access only a select group of quality-credentialed providers in exchange for lower premiums and out-of-pocket costs.
Health plan network strategy leaders use a variety of data sources to evaluate and improve provider performance and provider network adequacy. This data includes provider benchmarks, utilization rates, consumer satisfaction ratings, and other network KPIs.
Aggregating, cleaning, and normalizing this data is time-consuming. Once a plan launches in a new market, it can take more than two years to collect enough claims data to evaluate its network performance.
Invest in Technology
The right technology solutions are a crucial part of optimizing provider networks. For example, providing a platform that streamlines provider network management and enables data analytics can make a difference in meeting critical PNM objectives like minimizing network disruptions and improving member engagement.
Investing in network optimization and ensuring your infrastructure can handle growth is also essential. For instance, implementing redundancy measures to prevent hardware failures and leveraging cloud solutions to offload some workloads can reduce the strain on your local network infrastructure.
During budget planning, leaders should be ruthless about identifying non-value-generating initiatives and freeing up resources for investments that align with an updated enterprise strategy. Moreover, leaders should continually monitor technology investments to measure performance and ensure value delivery.
Using data analytics, network teams can improve performance by segmenting parts of the network. It reduces bandwidth utilization as endpoints communicate primarily within these segments and minimizes communication across the entire network. Services like VLANs and subnets also enable teams to prioritize applications, resources, and users based on bandwidth usage.
Optimizing provider networks benefits payers by ensuring accessibility to healthcare for members, increasing member satisfaction, and improving outcomes. Payers can achieve this by assessing network adequacy, cost efficiency, and marketability. Payers can use these strategies to create value-based provider networks and reward providers for delivering on that value. It can help them unlock synergy between their network design and payment strategies. Health plans should regularly verify provider data to maintain the accuracy of directories.