Industries

Helping clients meet their business challenges begins with an in-depth understanding of the industries in which they work. That’s why KPMG LLP established its industry-driven structure. In fact, KPMG LLP was the first of the Big Four firms to organize itself along the same industry lines as clients.

How We Work

We bring together passionate problem-solvers, innovative technologies, and full-service capabilities to create opportunity with every insight.

Learn more

Careers & Culture

What is culture? Culture is how we do things around here. It is the combination of a predominant mindset, actions (both big and small) that we all commit to every day, and the underlying processes, programs and systems supporting how work gets done.

Learn more

Elevate the Provider Experience: Strategies for Health Plans

Unlocking value through enhanced payer-provider collaboration

Even as the healthcare industry shifts towards value-based care and payer-provider partnership models, there is continued misalignment between payer and provider incentives and goals. While members are often the focus of customer-centricity, payers must also effectively improve provider experiences, ultimately benefiting members through affordability and care quality.

Payers can do this by addressing the most common provider pain points that exist across the payer operations value chain:

Through the following selective strategies, payers can collaborate with providers to improve experience and payer-provider relationships:

1

Streamlined, digital contracting: Seamless integration of simplified provider-facing channels with enhanced capabilities for provider processes, such as contract intake

2

Intelligent provider profiles and directories: A computerized, online system can compile data and details previously supplied, simplifying the procedure for both parties

3

Enhanced provider communications: An approach for simplified communications across channels of communication, supported by the right frequency and forums for updates and collaboration

4

Prior authorization intelligent decisioning: Integrated advanced analytics and workflow platforms with continuous machine learning models for decisions that support members’ best health outcomes

5

Point-of-Service claims payment: Producing, submitting, and processing claims electronically at the time-of-service, enabling immediate payment to providers and transparent pricing for members

6

Longitudinal health record: The ability to centralize and share member data through data standardization and connectivity for consistent, up-to-date information across payer and provider systems

Through these strategies, not only will payer employee and provider experience improve, but also payers may achieve a potential 3x–5x return on investment in administrative savings alone by applying the underlying capabilities across the organization and adopting these strategies. Payers who simplify collaborative interactions and foster trusted partnerships with providers will advance paired efforts to deliver better care to members and reduce costs.

Authors: Saurabh Goyal, Alex Fialkow, Analeeza Leggett, Anna Mazzuckelli, Nadia Syed

Dive into our thinking :

To learn more, please read our recent whitepaper on Elevate the Provider Experience

Download PDF

Explore more insights

Meet our team

Image of Saurabh Goyal
Saurabh Goyal
Advisory Managing Director, Health & Government Solutions, KPMG LLP

Thank you!

Thank you for contacting KPMG. We will respond to you as soon as possible.

Contact KPMG

Use this form to submit general inquiries to KPMG. We will respond to you as soon as possible.

By submitting, you agree that KPMG LLP may process any personal information you provide pursuant to KPMG LLP's Privacy Statement.

An error occurred. Please contact customer support.

Job seekers

Visit our careers section or search our jobs database.

Submit RFP

Use the RFP submission form to detail the services KPMG can help assist you with.

Office locations

International hotline

You can confidentially report concerns to the KPMG International hotline

Press contacts

Do you need to speak with our Press Office? Here's how to get in touch.

Headline