Why Enterprise Provider Network Management is Important for Health Plans

Why Enterprise Provider Network Management Is Important For Health Plans

Times are changing my friend. As someone in the world of provider network management, you know this better than most. From increasing turnover rates on all fronts to ever-morphing work environments and increasing oversight, it’s been a wild ride and one that shows no sign of slowing down.

Amidst this whirlwind, a new expectation has emerged: agility, responsiveness, and accuracy. We’re talking about quick, on-the-spot updates to your provider databases that flow smoothly into your network analysis and directories. Simply updating your provider data and checking your network status every few months is no longer enough. 

Now, here’s the deal: even if you hired all the people to manually update your data all the time, they couldn’t keep up. That’s why we’re big fans of incorporating Software as a Service (SaaS), cloud computing, and self-service solutions for provider data management and provider network management, and you should be too. Let’s dive into how these solutions give you undeniable advantages and why they’re a must-have in 2023 and beyond.

Provider Network Management Advantage #1: Optimize Operations

Streamline Processes and Consolidate Systems

First and foremost, making the switch from manual processes to automation will save you time—which in and of itself is basically like finding gold at the end of the rainbow—but the true magic lies in consolidating systems and streamlining processes across different teams within your company. Instead of everyone working on separate applications with different processes, you can bring everyone together on one platform.

Reduce IT Dependence for Software Deployment and Provider Network Analysis

Traditional network analysis methods often require IT teams to install software updates, leading to significant time constraints. With an enterprise provider network management solution, you can remove IT dependence. You’ll have direct access to the analytical tools you need right when you need them. It’s convenient, flexible, and a complete win for everyone.

Efficiently Achieve Milestones Through Enhanced Collaboration

When multiple teams work on a project together, it’s normal to come across obstacles that cause delays. Things like not having quick access to the same information—or the right information—confusion around the various compliance requirements, and reliance on manual processes can all contribute to these setbacks. That’s why it’s important to use a solution like Quest Enterprise Services (QES)TM to manage your provider networks.

By consolidating provider network information into one platform, Quest Enterprise Services increases visibility and provides actionable insights that streamline workflows and improve communication among teams. Easy access to accurate and timely data ensures that you, your teams, and your stakeholders can efficiently retrieve essential information. Result? A significant reduction in project completion time. Who doesn’t love that?!

Insider Tips on Enterprise Provider Network Management Adoption

Want to know more about implementing a provider network management solution for your organization? Check out the real-life insights from experienced leaders who have been through the process. James Lamb, VP of National Payers, Quest Analytics, and Karen Decaran-Voigt, SVP of National Networks, Molina Healthcare, share some of their tips and lessons learned. 

Catch the Full Conversation 

Enhance Your Provider Data Verification Process

Provider data accuracy is critical in provider network management. It’s also one of the most challenging. The good news is that with the right strategy, you can flip this whole process upside down and make it work for you.

One major key is having an approach that makes it convenient for providers to regularly verify their information, while also making it less complex for you. Take Quest Enterprise Services Accuracy, where provider outreach, attestation, and data inspections come together to give you an all-in-one picture of what’s changed, what’s right, what needs attention, and what your next steps should be. It’s like having a personal assistant for data management.

  • Compliance requirements? Check.

  • Efficiency and effectiveness? Double check.

By having the right methodology, you can reduce the workload for all parties involved and create a solid, defendable data management process that not only improves your data but also keeps you compliant. 

Provider Network Management Advantage #2: Solve Business Needs

Understand Network Trends, Identify Opportunities and Stay Compliant

Nobody likes being caught off guard. It’s a universal truth that surprises in provider network management can lead to unnecessary headaches and complications. Instead of reacting, you can actively manage your provider networks and address issues right away.

  • Are there any new gaps this week?
  • How are the networks performing month-over-month?
  • Are providers available to close a network gap?
  • Want to ensure the providers listed in your database match the population you serve?

With a less time-consuming way to constantly stay updated on the status of your provider networks, spot changes, measure progress, audit & analyze data, and identify areas that need improvement, you’ll make your provider network analyses more accurate and dependable. 

Forecast the Future and React with Ease

Knowing the status of your provider networks is great, but having the power to react quickly and pivot on a dime when things don’t go as planned is even better. Thanks to automated network modeling tools, you don’t need a crystal ball to see into the future. With these tools, you can evaluate numerous “what-if” scenarios effortlessly, and gain a quick understanding of how the adjustments will impact your provider networks.

  • Weighing the pros and cons of adding another provider group to the network?
  • Wondering what will happen when you remove the 60 providers who haven’t verified their information?
  • Considering expanding into a new county and want to make sure it’s the right move?

You can get all the answers with automated network modeling tools.

At the end of the day, it’s all about being future-ready, nimble, and making smart moves. These tools allow you to plan ahead, adapt quickly, and align your decisions with your organization’s goals.

Saving Your Medicare Advantage Contract: Quick Solutions for Provider Network Deficiencies

So, your HSD table has network deficiencies after sending it to CMS. Talk about stress! Where do you even begin when you desperately need to add providers to your network as fast as possible? Well, don’t worry! Eliza Hoffman, VP of Regional Payers, understands the overwhelming pressure you’re under and is here to guide you toward a swift resolution.

Provider Network Management Advantage #3: Adapt and Scale

Drive Transformation and Progress

An enterprise provider network management solution is not just a tool, but a catalyst for transformation and progress. Relying on traditional methods simply can’t keep up with today’s demands, or the demands of the future. By automating repetitive tasks, your team can focus on big-picture projects, explore new ideas, develop new products, and expand into new markets.

Break Down Barriers and Connect for Success

Data and organizational silos hinder growth. Transparency and collaboration have become crucial for success. That’s why fostering a teamwork-oriented environment within and outside your organization is essential. Think of it as building a bridge that brings together different parts of your business, promoting better communication, smoother coordination, and a seamless flow of information. By breaking down these silos, you can unlock a multitude of possibilities and better serve your patients through optimized processes and improved communication.

Future-Proof Your Business

The industry is always evolving, and it feels like change is happening faster than ever. To secure the future of your business, you need to address the present and plan for what lies ahead. That’s where an enterprise provider network management solution shines. With the right processes and tools in place, you’ll be equipped to meet changing demands head-on. No matter what challenges or opportunities come your way, you’ll be ready to conquer them with confidence and finesse.

Ready to break barriers, build bridges, and future-proof your business? Sign up today and join the ranks of successful enterprises leading the way to a brighter future.

More On Provider Data Accuracy and Network Adequacy

Stay up-to-date on the latest developments and best practices in provider data accuracy with these valuable resources! We’ve rounded up some of the most helpful articles on current network adequacy and provider data accuracy rules to help you navigate the changing landscape. Dive in now!

Proven Solutions for Your Provider Network Management

Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid and Commercial. Schedule a strategy session today and see how we can help you every step of the way.

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