Provider Management Solutions

Support your network providers and plan members with automated processes, more effective engagement, and comprehensive reporting tools.

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The Importance of a Provider Management Strategy

Health plans rely on their network of providers to deliver quality care to their members. Yet, to maintain a robust network of high-quality providers, plans need a strategy and modern, digital tools to manage their network effectively.

Effective provider management goes beyond operational tasks, it directly impacts quality of care, member satisfaction, and overall healthcare costs.

In recent years, there has been a growing realization in the industry of the strategic importance of managing the network provider lifecycle from end-to-end, along with the importance of investing in technology tools and platforms.

By taking advantage of today’s digital tools, health plans can achieve effective provider management and realize the benefits across their business, with their providers, and for their members.

The Health Plan

  • Improved Care for Members
  • Cost Efficiency
  • Member Satisfaction
  • Regulatory Compliance
  • Competitive Advantage
  • Streamlined processes for credentialing, contracting, prior authorizations, multi-departmental workloads, and more

The Providers

  • Streamlined Operations and Claims Processes
  • Payment Predictability
  • Education, Training, Professional Development
  • Enhanced Engagement Experiences

The Members

  • Access to High-Quality Providers
  • Cost Savings
  • Convenience of a robust network
  • Improved Health Outcomes
  • More accurate communication over appeals & grievances

Provider Network Management

To reap the full benefit to their organization, health plans must navigate the complex data and processes associated with the management of the plan’s network of contracted healthcare providers.

Provider network management encompasses the many processes related to the complex, and often manual, tasks associated with building the network – from recruitment through on-boarding.

  • Recruiting & Attracting Talent: Health Plans need to utilize modern tools that support targeted segmentation and recruiting with real-time marketing automation journeys, lead scoring and AI-powered process automation.
  • Credentialing & On-Boarding: Streamlining verification processes across multiple departments while ensuring regulatory compliance for audits enables health plans to improve internal resource allocation and reduce the time new providers wait to see patients.

    • ON-DEMAND WEBINAR

    Watch today to learn how we’re enabling health plans with the tools they need to alleviate some of the manual burdens associated with building their provider network.

    Provider Network Relations & Service

    The provider network is the health plan’s competitive differentiator in an increasingly retail market. Staying engaged with their providers and providing a high level of service can help health plans achieve higher levels of retention within their network – a win for both the plan and its members.

    The ability to engage with a provider in the right way and at the right time is dependent on a solid foundation of data and automated processes.

    Whether the plan is sending out education and training materials, managing claims or appeals, scheduling provider visits, compiling reports, or any number of other interactions, a modern toolset is critical to success.

    ON-DEMAND WEBINAR

    Watch on-demand to see how we’re helping our customers alleviate some of the manual burdens associated with delivering excellent service and engagement experiences with their provider network!

    Partnering with Health Plans on the Strategic Path to Success

    With decades of experience partnering with health plans, Hitachi Solutions understands the business case that surrounds investing in provider network management and we are here to help.

    We understand the importance of high-quality provider data – it is at the core of building a provider management strategy and improving the processes associated with every step of the provider lifecycle. Our provider data model takes into account the need for the scalability and flexibility that health plans need to ensure their business is set up for success in an ever-changing industry.

    Leverage our years of experience with the Microsoft platform and our industry-tailored solutions to modernize your provider management strategy, processes, and roadmap for the future. Get started with a conversation today.

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