One of the most demanding tasks for any payer is establishing a new provider network or expanding an existing one. Many factors must be considered, such as the payer’s revenue and growth trajectory, potential for the network to lower medical costs, and viability of the network to meet the member’s needs. These are just a few which are key to successful network builds, and we will explore how important they are to network administration. Because the contracting and credentialing involved is often time- and labor-intensive, payers rely on healthcare agencies like ARC to handle the paperwork and negotiations on their behalf. So what does a provider network strategy look like to us? Here’s a breakdown of the steps we take to ensure a successful partnership.
We’ll spread the word about your plan’s network build through website updates and social media posts, as well as recruitment blasts through email and faxes to local providers. In such a competitive landscape, payers must be ready to adopt more creative approaches to reach their target audiences. Simple ads and articles are no longer as impactful as they once were, and marketers must identify which channels their customers are more inclined to use. Social media, websites, email, fax blasts, radio, and television — all play a significant role in getting your message out about an upcoming provider network build or expansion.
The use of analytics is important in the creation of a quality provider network that supports the product being offered. These findings will drive plan decisions, from the targeted number of providers to recruit and the territories they need to cover, to the overall strategy and staff to allocate for the build. We’ll confirm the geographic region where you want to expand, whether at the city, county or state level, as well as incorporate your target goal for the total number of providers you need, divided among primary care, specialists, hospitals, and ancillary services. We’ll then review those available and compare their coverage area against the general population for network adequacy.
This step in the build comprises our entire engagement with these providers, from laying out your intended program with them, negotiating their reimbursements, and confirming a timeline for them to enter your network. One of the biggest pitfalls comes down to the paperwork, which is why we’ve opted to go digital: our proprietary software, Fourleaf, makes it easy for same-day changes to key areas of negotiation, whether it’s updating provider language and plan rates for contracts, or verifying the appropriate credentials regarding licenses, board certifications, and malpractice history. It boosts process efficiency and data accuracy, reduces turnaround times, and facilitates ease of reporting and provider directory production.
Reimbursement strategy and methodology is critical to provider network build success. There are multiple methodologies which vary by payer and by network build need. It is important to be familiar with the various methodologies and understand the price points a payer desires. You’ll close more deals faster if we enter negotiations knowing a) the price you want, and b) the price range you’re willing to accept. This avoids the trouble of having to tell a provider, “We’ll get back to you,” only to see them join a different network that was ready to accept their offer.
A lot of people can recruit, but they can’t document their findings in an orderly fashion. And that’s a big problem when it comes to your network adequacy. We provide a dashboard for any managed care plan so your team can review weekly reports on each provider we’ve engaged, and where they stand on joining your network. This information is also compared against your target goals for a particular region, so if you’re looking for x-number of primary or specialist care per y-number of enrollees, we can identify providers we still need to recruit.
Our reporting presents a clear view on how the providers for your network are performing, serving as a direct translation on how successful the product is in the market.
Once contracts have been signed and providers have confirmed start dates to enter your network, it’s time for us to pass on all related documentation to your team. This includes a quality checklist to confirm appropriate steps in the credentialing process are complete, and that providers meet your plan standards. Our handoff to you will be seamless so that you can circle back with them immediately and welcome them to your network.
Are you in the beginning stages of a new network build? Let’s talk about it! Drop us a line at +1 888-552-0677, or click here to submit a request through our website.
ARC Healthcare specializes in designing and delivering scalable solutions for the healthcare and insurance industries. We are your trusted partner for Provider Network Development, Consulting, and Support Services.