Healthcare on Overdrive: Why an Enterprise Provider Data Strategy is a Must for Health Plans

In the ever-evolving landscape of healthcare, where labor costs intensify and regulatory complexities surround provider networks and directories, health plans find themselves at a crucial juncture. The need to reimagine their approach to working with providers has never been more apparent. Fragmented engagement, siloed data, and disparate systems are becoming obsolete and unmanageable. To navigate this challenge, leading health plans are embracing an enterprise-wide provider network management strategy that reshapes core functions, ensuring efficiency and agility. Let’s delve into what this looks like.

Centralizing Control Through Provider Engagement Portals

The cornerstone of this transformation lies in centralizing control through comprehensive provider engagement portals. By unifying traditionally siloed functions like provider onboarding, enrollment, credentialing, and contracting, health plans gain a consolidated, data-driven approach to provider profiles that is not possible in legacy systems. This approach streamlines network development efforts, creating accurate provider directories across all business lines. Moreover, central decision-making authority fosters efficiency, eliminating duplicative efforts and enabling the establishment of universal workflows, technology infrastructure, and a cohesive team for sharing best practices and knowledge across the enterprise.

Driving Consistency in Provider Data While Enabling Flexibility within Markets and Networks

As responsibilities within health plans consolidate, a delicate balance emerges. Payers are successfully implementing a model for provider engagement that blends corporate standards with the ability to customize the workflow and data requirements based on network, state, specialty, and other nuances. The flexibility to govern policies and workflow process design, while maintaining the ability to tailor outreach, relationship management, and market-specific requirements, is crucial for success in navigating the dynamic healthcare environment. Technology solutions that facilitate both standardization and customization become imperative for the sophisticated governance and growth of health plans. Additionally, as health plans engage with providers across all networks such as Medicare Advantage, managed Medicaid, self-insured employers, commercial, and specialty networks, a core provider profile is necessary to track and engage with the provider within all or some of these networks.

Accelerating Speed-to-Value for Health Plans

Transitioning from disparate provider engagement, credentialing, and contracting activities to an integrated approach significantly accelerates activation into the network. An enterprise strategy allows health plans to seamlessly navigate recruitment, application processing, verification, credentialing, committee review, and contracting without the hindrance of time-consuming integrations between disparate systems. This approach ensures data flows seamlessly from onboarding to claims, resulting in an accelerated speed-to-value. Providers can become part of the network and engage in patient care faster. Larger health plans, in particular, have reported a compelling 14 times return on investment within the first year of using a comprehensive enterprise provider network management system.

The Time is Now for Enterprise Provider Network Management Systems

As health plans strive to grow market share, reduce friction with providers and streamline processes to reduce costs, an enterprise-class provider engagement strategy is mission critical. It is an opportunity to finally align provider network activities as a competitive differentiator. The urgency is palpable, especially considering new entrants into the provider or payer market have an advantage, unburdened by legacy systems. Failure to act quickly could prove detrimental to the ability of larger health plans to respond to market changes and capitalize on growth opportunities.

Larger health plans hold the key to providing efficiency at scale and making a substantial impact on eliminating waste and inefficiency in healthcare. The transformative collaboration between providers and payers is not a future consideration; it’s a present necessity. The time for health plans to adopt enterprise provider network management systems is now, to ensure they remain at the forefront of industry standards and offer a seamless end-to-end provider experience.

About the Author

About the Author

Tammy Hawes is CEO and Founder of Virsys12, a Healthcare Focused Salesforce AppExchange and Consulting Partner. Hawes launched Virsys12 in 2011, with a track record of more than 25 years of executive success.

About the Author

About the Author

Tammy Hawes is CEO and Founder of Virsys12, a Healthcare Focused Salesforce AppExchange and Consulting Partner. Hawes launched Virsys12 in 2011, with a track record of more than 25 years of executive success.