Health Plans are no exception here. In the rapidly changing healthcare landscape, expanding providers’ network, members seeking digital delight, and value-based care, Health plans counter several issues while managing their overall network. Hence, they are compelled to rethink their provider network management strategy.

Issues Plaguing Provider Network Management Lifecycle

From evolving regulatory regulations, membership expansion to value-based contracting, Health plans face numerous challenges across various departments. These departments include contracting, credentialing, and configuration. And, these challenges are likely to impact the overall provider network management process.

At present, there’s no unified system that can integrate with the flow of work involved in contracting, credentialing and configuration. It, therefore, leads to data management challenges, inefficiency, and higher administrative costs. Let us deep dive into myriad challenges, leading to distressed payers across the provider network management lifecycle:

  • Siloed Systems – As users from contracting, credentialing, and configuration departments work on disparate point solutions, it results in duplication of work and lowers productivity. Lack of an integrated system across all these departments leads to broken processes, low transparency, and unnecessary delays.
  • Fragmented Provider Data – Health Plans manage and store the provider’s data in disjointed systems. Most of these systems end-up working in their own silos, and resulting in disjointed business processes. The end outcomes are irregularities, errors, and higher reworking cost.
  • Manual and Error-Prone Processes – Most Health Plans hold their dependency on manual handoffs, resulting in data entry errors. Despite systems being available, their siloed nature requires people to manually enter or re-enter the provider’s data. This translates into the loss of data and documents during hand-off between multiple departments.
  • Compliance Risks – Since providers’ information is scattered across disparate and siloed systems, it becomes difficult for Health Plans to manage data in a methodological way. The inability to track the provider’s required history and past actions, and difficulty in enforcing policy and procedures, gives compliance nightmares to Health plans.

Need of the Hour – Adopt the Next Generation PNM Solution

To take the winning leap, it is an immediate requirement for Health Plans to replace their aging contracting, credentialing and configuration point solutions. They may adopt the next-generation provider network management solution to streamline the overall process and provide enhanced services to providers and members. The integrated PNM solution will comprise of provider contracting, credentialing and configuration, all, within a single suite.

By leveraging the integrated PNM solution, Health Plans can eliminate system/ departmental silos and optimize the complete provider network management process. By rendering this right-fit solution, Health plans can effectively counter the data management challenges, foster providers’ relations in the long-term and thrive in the dynamic Healthcare environment.

So, instead of seeking temporary relief, Health plans must seek permanent solace. They ought to make PNM solution a part of their digital strategy and make a smart move towards gaining process excellence.

As rightly said by – Heraclitus, the pre-Socratic Greek philosopher, “Change is the only constant.” The quote stands true for mankind. Those who resist changes succumb to nothingness.