What is Good Healthcare Provider Network Management?

The healthcare industry is heavily regulated in the US. While some practitioners and medical organizations hate the slow credentialing and complex administrative processes, this practice ensures the highest quality of service. Further, through good policies, the government can prevent unlawful practices.

In this article, we want to focus on the top of network management. Similar to everything else in healthcare, good network management is vital for regulating these services and ensuring compliance.

Network management basics

Network management is crucial for everyone involved in the process, from patients to healthcare plans and providers. In fact, the process is so important that some health plans invest lots of resources in streamlining it.

While network management tends to be complicated, often requiring months and even years to set up, it yields dividends over time. Health plans can start noticing the returns after a few years, which is why it’s critical to take your time to properly execute the procedure. In the end, if you don’t have good provider network management, patients won’t stick with you for long.

Besides health plans, the process is also vital for providers. Through good network management, practitioners can avoid common administrative hassles and focus on their craft. If done correctly, network management can build relationships between health plans and medical providers, ensuring long-term cooperation that would benefit both sides.

Lastly, we can’t neglect the impact quality provider network management has on patients. When providers don’t have to think about administrative processes, they are more focused on their service. A common practice is to align providers’ goals with patients so that the medical practitioners have an incentive to provide the highest quality care.

Network management lifecycle

While there are some minor discrepancies to the network management lifecycle, here’s how the process generally looks like:

  • Data collection from providers, medical organizations, and patients, all of which intend to improve patients’ care
  • Handling of claims, billing statements, and reimbursements for various medical services that practitioners provide to their patients
  • Building and reinforcing relationships between different stakeholders in an attempt to make them stay with the health plan
  • Continuous oversight of providers’ licenses, certifications, and potential penalties to ensure regulatory compliance
  • Periodic re-credentialing of providers and medical facilities
  • Managing practitioners’ relocations and retirements and finding ways to fill the gaps in specific markets

Also read: How Healthcare is Changing?

Setting the basis for a good healthcare provider network management

In many ways, creating a viable, long-term network management process is similar to managerial processes in other industries. Specifically, health plans need to be flexible when creating a strategy, continuously testing and improving their methodology. Stakeholders have to be on the same page all the time, thus reducing errors and backtracking.

In most cases, organizations that have good network management also have a holistic mindset. They look at things from a long-term perspective, putting special emphasis on network building from the get-go. These health plans are generally proactive, looking for future gaps in their network and patching them before they occur.

The best way to determine if a health plan is flexible enough is by analyzing the earliest development. For example, common malpractice is overcommitting to specific networks, which leads to market saturation. In these cases, health plans don’t fully understand market requirements, which is why they don’t reach CMS adequacy standards.

To effectively manage a network, a health plan needs to establish a basis for collaboration. Teams should have an open channel of communication with each other and have well-defined, measurable goals. Among others, all team members should have access to the same information to avoid potential discrepancies.

According to Andros, a reputable CVO, modern organizations should invest heavily in their software to streamline the entire process. Ideally, teams should have access to a single SaaS platform that would adjust relevant data in real time. Through the use of software, teams can easily decide on goals, set deadlines, and avoid errors.

Focus on long-term management

When first starting with their network management, most healthcare providers don’t realize how much effort this process requires. Not only does it require a hefty initial investment, but it also requires continuous work on updating information and filling the gaps.

Setting a good basis will make it much easier for healthcare organizations in the future, as it will reduce, sometimes eliminate, arduous administrative work. As a result, the entire process will be better streamlined while also minimizing otherwise high costs.

Upon launching the network, healthcare organizations can rely on advanced software to monitor all members and their status. The same program can automate re-credentialing. With advanced tools, organizations can eliminate any hitches and minimize human errors.

As previously mentioned, an optimized process benefits everyone involved, from patients to providers and health plans. Most notably, it eliminates the common stress associated with all the arduous administrative tasks. That way, members can perform their duties at a high level, at everyone’s pleasure.