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:
Streamlined, digital contracting: Seamless integration of simplified provider-facing channels with enhanced capabilities for provider processes, such as contract intake
Intelligent provider profiles and directories: A computerized, online system can compile data and details previously supplied, simplifying the procedure for both parties
Enhanced provider communications: An approach for simplified communications across channels of communication, supported by the right frequency and forums for updates and collaboration
Prior authorization intelligent decisioning: Integrated advanced analytics and workflow platforms with continuous machine learning models for decisions that support members’ best health outcomes
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
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
