Best practices for provider network administration

Network administration is important to improving both revenue growth and outcomes while reducing medical spend. However, increased demand from consumers, providers and regulators can make network construction and management more difficult.

A sound network capable of meeting different network adequacy requirements helps to support expansion into new markets, exchanges, Medicare, Medicaid, etc., Advanced reimbursement models, specifically to support value-based reimbursement, also factor into the network’s alignment and ability to remain competitive.

There are three best practices health plans can follow to achieve optimal provider network performance:

Best practice #1: Apply analytics
With analytics, you can drive key findings and inform decisions to create a higher quality network that will support new product offerings. To decrease the time it takes to identify whether a gap has closed or a new gap has opened, align adequacy analysis directly with the network source of truth. Use intelligent recruitment analytics (cost, quality, utilization) to help close gaps by recruiting providers that cover the largest membership gaps.

To see how reimbursement analytics can help you manage your network, click here.

Best practice #2: Reduce the number of touch points
It’s no surprise that strong collaboration with your providers creates a strong network. The more you engage your providers, the more likely they are to see the benefit of new offerings for their patients and be willing to deliver the extra effort to make new offerings a success. But make that engagement easier by reducing the time and touch points necessary to maintain your network. Look for approaches to streamline processes and improve data integrity through fewer stops.

Best practice #3: Strengthen provider relationships
Value-based care models that have strong outcome-based results help encourage providers to embrace and champion new products. Share analytics about the value of the new service or network enhancement with your providers. Doing so can reinforce how the improvements will improve cost of care, patient outcomes and overall satisfaction.

Three tools for providing clear, consistent information can be found here.

Maximize the power of your provider network
Payers that understand how to increase the value of their provider network will be able to get to market faster and more effectively with new product opportunities, while reaching and retaining a larger member set. For more insight into strengthening and managing provider networks administration, download our white paper, “Provider network administration: A strategic point of differentiation.”


About the Author:

David Mauzey

General Manager, Optum Provider Network & Data Management

David Mauzey is the General Manager of Optum’s Value Based Care(VBC) & Provider Network Data Management (PNDM) suite of solutions and services that include the PNDM platform, VBC products and Bundled Payment solutions. These products bundle together to enable an organization to manage all aspects of provider network management. The solutions perform identification of network gaps, recruitment, credentialing, product/contract management and fee-for-service claim pricing. From a valued based care perspective, the solutions provide an end-to-end value based care program focusing on customizable attribution, roster management, VBC contracting, VBC payment and bundled payment reimbursement.

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