Expanding your footprint is an exciting opportunity for your business, but it also comes with its fair share of challenges. One of the main hurdles is quickly and efficiently finding providers who align with your network needs. Let’s explore best practices for identifying providers and streamlining the process to ensure efficient network expansion.
Common Challenges with Provider Network Expansion
Challenge #1: Accessing Readily Available Provider Lists
Everyone wants quick and easy access to lists of available providers. Unfortunately, many organizations don’t have this information readily available, leaving them to rely on manual internet searches, competitor directories, or outdated claims data. Not only are these approaches time-consuming, but they can also compromise data quality and lead to costly network revisions in the future.
Challenge #2: The Growing Wish List and The Limited Pool of Providers
As the wish list of requirements for the ideal provider keeps growing, organizations often find themselves in a situation where the pool of qualified professionals is dwindling. Geographical elements and limited data visibility further complicate the search for providers who check all the boxes.
Challenge #3: Managing Multiple Tools and Systems
The use of multiple solutions for provider data management, network analytics, provider verification, and other aspects of network expansion can lead to confusion. Operating with disparate tools and systems creates repeated work for teams involved in provider network expansion, making the process inefficient and prone to errors.
Challenge #4: Avoiding Analysis Paralysis
Knowing where to start and how to navigate this intricate process can be overwhelming, especially for organizations new to such initiatives. Changes in delivery models and network requirements add complexity, causing analysis paralysis that hinders progress and prolongs expansion efforts.
Challenge #5: Balancing Network Adequacy with Expansion Goals
Meeting network adequacy requirements is crucial for both current and potential networks, be it Medicare Advantage, Medicaid, or Exchange. Striking the right balance between finding providers who meet these requirements and align with your network goals can be a delicate task.
5 Best Practices for Efficient Provider Network Expansion
Best Practice #1: Engage Stakeholders and Set Clear Goals
Work with all stakeholders involved to define goals, timelines, and provider selection criteria. Having a North Star helps ensure all efforts align with overall business goals.
Best Practice #2: Streamline Evaluation Processes with Automation and Centralized Views
Evaluating healthcare providers is time-consuming and resource-extensive. Consider using an enterprise management solution that features automation and centralized views. This technology streamlines your analysis and comparison processes, saving time and resources. With customizable views, stakeholders can make informed decisions about network expansion while efficiently managing larger networks without compromising quality or efficiency.
Best Practice #3: Move Beyond Data Files to Actionable Insights
Data files alone are not enough. You want actionable insights that allow you to take action and make smart decisions. By using advanced analytics and machine learning, you can quickly gather additional information about potential providers, helping you identify critical information such as the right provider at the right location.
Best Practice #5: Evaluate Providers with More Metrics
While traditional metrics like time and distance are essential, you want to consider other factors when evaluating providers. These factors include quality of care metrics like provider outcomes, top procedures and conditions, as well as cost and quality scores. By adopting a multi-dimensional evaluation approach, you can identify providers who excel in multiple areas, leading to a network that provides high-quality care focused on the patient.
Best Practice #5: Stay Ahead with Adaptive and Compliant Provider Network Management Solutions
Adaptable and regulation-compliant provider network management solutions are crucial for long-term success. Select solutions that adjust to evolving industry regulations, technological advancements, and market dynamics. By investing in these solutions, you can effectively respond to changes and ensure your provider network remains efficient, compliant, and competitive.
Optimize Your Network Expansion Strategy with Quest Analytics
Unlock the full potential of your network’s growth and expansion with Quest Enterprise Services Provider Claims Insights. By accessing detailed data insights on provider claims activity, top conditions and procedures, payer mix, and efficiency metrics, you can make informed decisions that power your organization forward. Want to learn more about efficient provider network expansion? Contact us to start your journey toward an optimized and streamlined network expansion process.
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.