3 Ways to Improve Provider Network Management

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3 Ways Hitachi Solutions Task Manager Can Improve Provider Network Management

To put it simply, provider network management is complex. 

There are layers upon layers of processes, paperwork, requirements, guidelines, and compliance peppered throughout the provider management lifecycle – and numerous tasks and steps involved at each point of the cycle. But without proper provider network management, health plans can struggle to manage and support their relationships with providers, physicians, and members who want a robust network of high-quality providers.

Highly effective provider network management is achieved by leveraging fully integrated, technology-enabled services, coupled with modernized processes and effective data management to excel in providing support for:

  • Onboarding
  • Credentialing
  • Enrollments
  • Privileging
  • Appointments
  • Quality Improvement
  • Risk Management

If the health plan enhances its network management processes, it can foster stronger retention among its providers. This retention is advantageous to both the plan and its members, as the strength of the network is a competitive differentiator for the plan and these providers are the ones directly delivering high-quality patient care to the members.  This is where the right provider management tools and processes come into play to streamline communication, build strong relationships, and align providers with their organization’s values, vision, and mission.

3 Vital but Complex Provider Network Management Processes  

Top-tier plans implement oversight, collaboration, performance-based contracting, and incentives to manage their healthcare providers effectively.

Additionally, research by Milliman indicates that health plans awarded the highest star ratings by the Centers for Medicare and Medicaid Services incorporate robust provider management strategies into their operations. Notably, plans with higher star ratings also tend to attract and retain more members compared to their lower-rated counterparts.

Today, I want to focus on three critical provider network management processes and the challenges they present:

1. New Contract Management:

  • Complex Negotiations: Establishing contract terms that satisfy both the healthcare provider and the payor can be intricate and time-consuming.
  • Compliance with Regulations: Contracts must adhere to a multitude of healthcare laws and regulations, which can be challenging to keep track of and interpret correctly.
  • Financial Implications: Setting rates that are competitive yet financially viable for both parties can be difficult, especially in markets with varying reimbursement models.

2. Onboarding & Credentialing:

  • Timeliness: The credentialing process can be lengthy, delaying the time it takes for new providers to start seeing patients and for healthcare organizations to begin billing for their services.
  • Data Management: Maintaining accurate and up-to-date provider data requires robust systems and processes, which can be resource-intensive.
  • Verification Process: Rigorous verification of providers’ qualifications, history, and certifications is necessary to ensure quality care but can be a complex and meticulous process.

3. Renewals & Ongoing Engagement:

  • Tracking and Monitoring: Keeping up with numerous contract expiration dates and renewal terms is challenging and requires systematic tracking methods.
  • Maintaining Relationships: Keeping providers engaged and satisfied with the terms of their contract over time necessitates continuous relationship management and communication.
  • Adjusting to Changes: Healthcare is a dynamic field, and contracts or policies may need to be adjusted for changes in regulations, market conditions, or organizational policies, which can be a complex process.

3 Ways to Improve Provider Network Management with Task Manager

Hitachi Solutions Task Manager is a robust and user-friendly tool that integrates across your business applications to coordinate complex processes seamlessly and easily. Task Manager utilizes customizable templates that standardize workflows and dramatically simplify the coordination and collaboration of a diverse range of tasks.

Task Manager harnesses the capabilities of Microsoft Power Platform, Dynamics 365, Outlook, SharePoint, and Teams, creating a cohesive platform for users. This synergy enables seamless collaboration and cross-system work, enhancing productivity and efficiency. 

Task Manager users have seen an 80% reduction in time spent on manual, spreadsheet-driven processes.

So how can a modern solution like Task Manager help providers with New Contract Management, Onboarding & Credentialing, along with Renewals & Ongoing Engagement?

Contract Management – Task Manager allows you to streamline the entire management of contracts, from prepping and negotiating, to approvals and DocuSign integration. Task Manager serves as your process management hub – a central location where you can see task statuses in real time, collaborate, share documents, and more. As one task is complete, it signals to the next person in the chain their task is due next. And because tasks are tracked at a granular level, you’re able to run reports and track them through analytics to find successes and gaps in your processes and performance.

Onboarding & Credentialing – Once a contract is signed, you need to set them up in your system, which can cross multiple departments with lots of paperwork. Your teams will be checking primary source verification, working with a Credentialing Verification Organization (CVO) for background checks and diploma verification. There’s also some education of portal onboarding and site visits that need to be conducted.  Task Manager covers every step across every department. Tracking by task also gives you all the audit information you need down the line for organizations like the National Committee for Quality Assurance (NCQA) and other accreditation organizations that offer comprehensive programs that evaluate the operations of organizations and full-scope credentialing services, which include verifying practitioner credentials, designated credentialing-committee review of practitioners and monitoring practitioner sanctions. Task Manager centralizing your audit trail to shorten time and improve availability of providers.

Renewals & Ongoing Engagement – In some ways, managing a provider network is kind of like managing a member relationship in that we want to keep them happy. Happy providers will stay in the network and represent your plan well when talking to members, and we want to keep them up to date with ongoing quality improvement initiatives, education materials, and more. You’ll also have site visits to ensure they are up to standards, compliance, and attestation, which are all crucial for maintaining the integrity of the healthcare system, ensuring that provider directories are accurate for patient referrals, and that providers comply with healthcare standards and contractual obligations with healthcare plans or networks. Task Manager helps maintain all the processes around engagement, but also uses automated, templated workflows to make sure you’re in front of renewals before they’re due – giving your teams the appropriate times to get accomplish every step of that process.

A Healthy Future for Provider Network Management with Hitachi Solutions

Health plans have hundreds of steps involved throughout their network management processes. And it’s likely to only become more complex. The ability to streamline every facet of the provider lifecycle is not just beneficial – it’s imperative.

Adopting modern tools like Hitachi Solutions Task Manager can transform daunting tasks into manageable ones, ensuring that provider management is not a roadblock, but a pathway to delivering superior care and enhanced patient experiences for members. Plans who modernize their network management will not only keep pace with industry standards but will set new benchmarks for efficiency and quality.

If you are ready to modernize your provider management capabilities, check out our related webinars on modernizing provider recruitment & onboarding, or modernizing provider service & retention, or contact us today.