Provider Contacting – A Business Lever for Health Plans

“Life is about balance, “my yoga teacher likes to say. “You have to balance both the good and the bad, and hope for the best”. Scrolling through the news on my phone every morning, I have been bombarded with headlines about the potential ACA repeal. Health Plans could likely use...

“Life is about balance, “my yoga teacher likes to say. “You have to balance both the good and the bad, and hope for the best”. Scrolling through the news on my phone every morning, I have been bombarded with headlines about the potential ACA repeal. Health Plans could likely use some balancing right about now, I have thought to myself more than once. But hoping for the best is not a good strategy. Instead, I recommend that Health Plans should be ready to put into place the best business levers that will assure success (no matter what happens to the ACA).

To succeed in the current and future environment Health Plans need to keep up with the increasing expectations of savvy members and adopt digital provider management systems to enter the modern world. How can they get there?

Unleash the power of Contracting!

Health Plans are facing increasing pressure to alter their service model as value-based contracting has come into play. Provider contracting no longer remains a backend activity, it has become a lever for competitive advantage and speed.

Here’s why:

  • Provider contracts forms the basis of a relationship between providers and health plans by determining the type of services rendered, define SLAs and outline the fee structure
  • Contracts impact the incentivizes for expected outcomes, allow adherence to regulations and follow best practices
  • Contracts ensure accurate claims processing for members and service payments to providers, enhancing member experience and gaining operational efficiencies
  • Effective contract management results in reduced claims processing errors, better reconciliation between member services and provider payments, resulting in reduced administrative costs

A Five Point Action Plan

To address the challenges we face in the modern world or the new normal for healthcare, Health Plans need to leverage technology and act now. Here at Newgen we have created an action plan to transform your provider contracting process from being an operational bottleneck to a business enabler. Download this whitepaper to learn how to execute this five-point action plan for Modern Provider Contracting.

Sonali Nigam Sonali Nigam is Director of Strategy for the Healthcare & Life Sciences COE at Newgen. She has an interdisciplinary background in engineering, health policy and management and has worked at leading healthcare organizations over the past decade.