Becoming a Medicare Advantage Plan of Choice for Providers


Effective, high-performing providers are the lifeblood of a successful healthcare network. When they’re not worried about things like paperwork and reimbursements, providers can focus on their patients and deliver quality care. On the flip side, providers who spend too much time behind a desk, dealing with administrative headaches rather than treating patients, struggle to do so.

In the increasingly competitive Medicare Advantage space, it can be difficult to identify, recruit, and contract enough providers to reach adequacy, much less create a healthcare network that attracts the best possible providers to join. But it’s not impossible. The path to building an exceptional provider network starts by focusing on delivering the best possible provider experience. 

That may sound like a pipe dream, since healthcare–and Medicare Advantage in particular–is a high-stakes, highly regulated, and potentially litigious industry. Here are four steps health plans should consider taking to secure the best possible providers in today’s competitive environment. 

Understand your strengths and weaknesses

Everyone has heard Socrates’ philosophical maxim, “Know thyself.” It doesn’t just apply to people; it’s also true in business. For health plans looking to build more provider networks, success starts with an internal assessment of strengths and weaknesses in recruiting, contracting, credentialing, and compliance.

Do your recruiters have to spend too much time and effort completing manual workflows and correcting preventable errors? Do they have all the information they need at their fingertips, or do they struggle to reach providers because they’re working with outdated or incorrect information? Once providers agree to join the network, is the credentialing process smooth and seamless, or do providers spend months waiting before they’re able to start seeing patients. 

It’s critical for health plans to get their networks up and running quickly, so patients have access to care when and where they need it

The easiest way to address gaps in these processes is with seamless, coordinated processes supported by purpose-built technology. Tools that can facilitate the recruiting, contracting, and credentialing processes have the potential to reinvent the provider network development process. They include:

  • Outreach management systems
  • Provider-facing portals
  • Automated credentialing platforms

Identify opportunities to improve the provider experience

To improve providers’ experiences, health plans need to identify the friction points across their provider interactions, starting with the recruiting, contracting, and credentialing process. 

  • Fine-tuning provider outreach and recruiting: Measure the effectiveness of various outreach tactics to maximize your success rate. Move away from “spray and pray” approaches to target providers that are more likely to be responsive. Use low-cost techniques where possible and then shift to high-touch recruiting efforts when necessary.
  • Reducing administrative burdens during contracting: Give providers self-service options. Leverage information gathered during the recruiting process, rather than requiring redundant paperwork.  
  • Streamlining provider credentialing and onboarding: Begin credentialing providers on a rolling basis rather than waiting for the network build to be complete. Standardize onboarding processes so provider groups can begin providing services quickly.
  • Strengthening compliance and network maintenance capabilities: Avoid surprises by monitoring the providers in your network for sanctions, license status changes, and other events that may affect their eligibility to provide services.  


Make competitive offers in ways that matter to providers

Healthcare providers, like any other person, don’t want to haggle unnecessarily. Don’t waste their time and make sure they feel appreciated by making reasonable, good faith offers, rather than trying to maximize short-term profitability at the expense of providers’ goodwill. What does that look like? 

  • Rather than negotiating everything, take the time to understand the local market and offer competitive reimbursement rates. 
  • Trust providers’ clinical judgment and streamline approval processes, so patients get the care they need, whether it’s a specialist visit or a medical procedure, quickly. 

Communicate according to provider preferences

Providers are people–communicate with them like they are. Even when you’re reaching out to a business, like a hospital or a provider group, you’re still reaching a person on the other end of your letter, email, fax, or phone call. Track providers’ preferences and use their preferred means of communications whenever possible. Have a playbook to escalate outreach efforts when necessary, but avoid tactics that are likely to frustrate or annoy the person on the other end.

Provide an easy-to-use interface providers can use to access all the information they need from you, as well as to update information on themselves and their business. Use it for two-way communication not only during recruiting, contracting, and credentialing, but also to facilitate collaboration between providers and the health plan on patient care, billing and reimbursements, and other administrative matters.

Focusing on creating positive provider experiences has many benefits. It’s like making a long-term investment that can yield returns year after year, rather than prioritizing immediate returns. Creating win-win situations with providers enhances your health plan’s reputation in the market, making it easier to recruit and contract providers for new networks and to fill gaps in existing ones. It positions you well to outmaneuver the competition and become the Medicare Advantage plan of choice for providers.

Take a deep dive into the provider experience in our ebook, Creating a Better Provider Experience: andros Survey Insights.

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