Strategic Planning prior to provider network development is often the last thing on executive’s minds. When going into a new, or expanding on current markets, there never appears to be enough time, or money, to take this essential step. While most managed care organizations have a simple project plan covering most of the ins-and-outs of provider network development, markets are so different these days that planning for specificities is overlooked and can later cause issues with a network build. You have heard that saying, “Once you’ve seen one Medicaid plan, you’ve seen one Medicaid plan.”
Most requests for proposals, whether through public health or commercial channels, come with requirements to outline the managed care organization’s provider network or plan to obtain one by the implementation date. Promises are made to assure complete compliance and patient access before any go-live date. These promises can get managed care organizations into hot water when not fulfilled. Strategic planning is the first crucial step to creating a road map, having a sense of direction, and establishing measurable goals through the process.
How do you create a plan that provides the level of detail you need for success in network development? Start with the basics!
First, make every effort to understand your client’s needs. For example: why are they asking questions about a certain service area or provider type? You can be sure there have been problems in these areas in the past – complaints and grievances, access to care, or other high-profile issues where difficulty was experienced. Also, as a part of client needs, think about regulatory guidance. If your provider network does not meet the minimum threshold of these requirements, the remainder of the work doesn’t matter. Next, think about the solutions you are offering. What makes an organization stand out over all the options? Once the initial step of the why and how is complete, the details can then be flushed out for the who, what and when.
When using the strategic planning process, an organization can ensure consistent and relevant provider recruitment. What services areas are covered? Which provider facilities and groups will be needed in the network? Is there a specific specialty where network-gaps may be found? These are all questions to ask during this phase of the process. Having a targeted list and prioritizing the list of providers is essential. For example, your strategic plan should take into consideration the amount of time it takes to contract with providers – especially the big ones. Contracting and subsequent credentialing are not overnight activities.
As a part of the planning stage, assigning roles and responsibilities to keep the organization aligned is very important. There tend to be many players involved in large provider network builds and by making assignments, there is less likelihood of tripping over one-another and more likelihood in getting all the tasks done timely. This stage also sets a level of accountability – again keeping everyone aligned.
Lastly, it is important to set milestones and checkpoints upfront, so expectations are outlined from the beginning. Consider using data analytics to drive your process and decision making based on facts and real-time information. When setting up milestones, knowing something is complete and confirming through data can be the difference between success and failure. Remember, provider network development is always dependent on network adequacy. Make sure and measure your progress along the way.
All in all, strategic planning when developing provider networks is essential to a successful network build. The scrutiny that managed care organization experience based on network development is huge! Taking this often missed step will ensure you’re ready for that go-live date, and patients will have ample access and satisfaction with your plan.