Provider Network Management Trends: What’s In Vogue For National Payers

As the second half of the year gains momentum, we can’t help but turn our attention to the hottest trends that are making waves in the health insurance industry. While Vogue may set the style agenda for fashionistas, it’s the national payers who are leading the way with trends that are transforming the way health plans operate.

These trends not only have the market’s current attention but are also likely to continue into 2024. So, grab your front-row seat as we dive into the hottest trends on the national stage. 

Trend 1: Telehealth—Accessory or Staple?

Remember how picking up your phone and consulting with a doctor became one of the wins during the pandemic? Well, with in-person visits making a comeback, national payers are wondering: What role does telehealth play in the future of provider network management?

While payers recognize the benefits of offering telehealth services, there are still some grey areas that need to be ironed out. 

  • Telehealth Parity: Should telehealth visits be reimbursed like in-person visits? 
  • Network Adequacy: Will the same telehealth credit be applied to network adequacy standards in all markets going forward? 
  • Health Care Delivery Ecosystem: Is telehealth an integral part of the overall continuum of care?

It’s safe to say that telehealth is like a trendy accessory trying to establish its place in healthcare delivery. We like it, but now we must figure out how to incorporate it seamlessly into every outfit. 

Developing Health Policy Frameworks For Telehealth Credits and Network Adequacy Standards

Want to learn more about how we’re working with regulators and health policymakers to design better-tailored telehealth credits for network adequacy standards? Download our white paper!

Trend 2: Provider Quality Measurements—From Fashionable to Functional

Everyone wants timely service, accurate diagnoses, and speedy treatment, but from a payer’s perspective–how do you quantify that? Provider quality measurements continue to be a point of conversation in the health insurance industry. While most payers provide some quality score for their members, there is little consistency across different plans and payers. This lack of uniformity can make it challenging for both payers and members to make informed decisions about healthcare providers. 

On the flip side, more payers are using provider information such as cost and quality in creative ways to design and maintain their networks. As this trend gains momentum, it’s essential for all of us to stay in the loop. Keep an eye out for the different ways payers are transforming quality measurements from mere fashion statements into powerful tools for network design and management. 

Trend 3: Provider Network Data—More Than a Fashion Statement

Provider network data is not just a fashion statement—it’s a reflection of the healthcare journey. As such, we’re witnessing a continued trend of improving provider data accuracy and integrity. When provider data is accurate, members can experience a seamless healthcare journey. On the other hand, outdated or inefficient data-gathering techniques can lead to frustration and roadblocks. That’s why national payers use an enterprise provider network management solution to address provider data accuracy and integrity as they step out into the streets. 

National payers are going all out to improve provider data, paying attention to every detail, and seeking new insights. With accurate and ongoing analysis, they’re improving the foundation for a fabulous provider network. Who said data can’t be the best-dressed element in the health insurance industry?

Do you want to discover how national payers use data insights to enhance their provider networks? Watch this video

Trend 4: Health Equity—Creating An All-Encompassing Network

Payers agree that creating a health plan where people of any language, ethnicity, or orientation can feel comfortable is essential. However, privacy rights introduce complexity into the equation. Opt-outs for data collection points can make it challenging to build an all-encompassing provider network. 

Despite these obstacles and ongoing discussions about regulatory standards, the need for health equity is growing. That’s why national payers are preparing for anticipated amended regulatory standards. One way they are doing this is by finding a way to gather a clear picture of their population and match their networks to the various unique needs.

Discover the four key takeaways on how regulators prioritize health equity and network adequacy standards. 

Consistent and Accurate Provider Data—Always in Vogue

All four trends share one thing in common: they rely on consistent and accurate data. Just like the staple pieces in your wardrobe that never go out of style, accurate and reliable data is always in vogue.


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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