Provider Network Management Resources
Take deep dives into provider network management news, best practices, and technology with expert members of the andros team.
Breaking Through Provider Fatigue: How andros Uses Data and Analytics to Build Better Medicare Advantage Networks
Since its launch by CMS, Medicare Advantage (MA) has transformed healthcare in the United States. As a result, Medicare beneficiaries now have more options and insurers are competing on price and quality, which has led to lower healthcare costs and better healthcare outcomes. It seems like a win-win scenario for health plans and consumers… until you recognize which group is
What does good provider network management look like?
The challenges of building a provider network are well-known in the healthcare industry. Network development teams must identify sufficient healthcare providers and facilities within a geographic area to meet patient needs, then recruit, contract, and credential them. If they’re building a network for Medicare or Medicaid patients, meeting adequacy requirements and submission deadlines complicate the calculations required. Only then can
Is Adequacy Enough? Moving Beyond CMS Standards for Provider Networks
Meet Grace Meet Grace. She’s a 70 year-old immunocompromised woman living in a rural area. She owns a car but doesn’t drive anymore, so she relies on her son for transportation. When she’s able to schedule her medical appointments well in advance, he’s able to take time off to drive her to them. But what happens when she comes down
Q3 Primary Care Provider Market Study
“ Primary care providers are more interested in acquiring new patients with their existing health plan contracts then they are in signing contracts with additional health plans ” andros executed our Q3 Provider Market Study to better understand primary care provider sentiment around network contracting and access to specialist providers for their patients. Part of what compelled us to focus
More Than Adequate: Paving the Road to Health Equity with Next-Gen Provider Networks
Download Our Whitepaper “ Of all forms of inequality, inequality in health is the most inhumane ” There are three main contributing factors for health inequality in the U.S.² — not to mention how we structure them to serve the needs of communities. Although provider network adequacy standards exist at the federal level and are one of the ways that
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
Improving the Patient Experience Using NCQA Report Cards
NCQA, the National Committee for Quality Assurance, is very clear about its mission: “We work for better health care, better choices and better health.” One tool they use to improve care is the NCQA report card program. NCQA report cards evaluate clinicians, practices, and health plans on a simple five star grading system. Since NCQA issues report cards for health
Solving the Top Provider Data Challenges in Network Development
Organizations of all sizes have struggled to solve the challenges of building healthcare provider networks, especially for Medicare Advantage, on schedule and on budget. Healthcare organizations have to analyze patient demographics and local geography, then make wise choices where to invest. They need to comply with complex regulatory requirements and demanding timelines. But despite these geographic and regulatory challenges, provider
10 Reasons Why Provider Network Development is Broken
The process of building a provider network is challenging. There is constant change in government regulations, a fast-paced competitive environment, and various information sources. Building a solid and profitable network requires the right strategy. The best network to build will depend on such things as your goals and member population, but network development strategy mistakes will prevent you from building
Creating a Better Provider Experience: andros Survey Insights
Introduction Building strong, healthy provider networks is anything but easy and absolutely critical to the success of every health plan. The healthcare industry continues to accelerate investments in digital healthcare tools and platforms (e.g., telehealth, remote patient monitoring, remote meetings, etc.) that disrupt traditional payment and communication barriers. M&A activity is accelerating at a breakneck pace, leading to consolidation that
What Does CMS’ Final Rule for 2023 Mean for You?
What Does CMS’ Final Rule for 2023 Mean for You? https://youtu.be/gUEZLcW84aY In late April 2022, CMS announced the changes to the Medicare Advantage (MA) program for 2023, and the implications for health care organizations submitting provider networks for approval for plan year 2024 are major, to say the least. If, like most, your organization finds itself scrambling to complete your
From Direct Contracting Model to ACO REACH: Navigating the Continued Evolution of Value-Based Care in Traditional Medicare
With a speedy makeover for the Global and Professional Direct Contracting Model, CMS is making sure to incorporate lessons learned from previous value-based care programs. The revamped ACO REACH initiative aims to make it easier and more rewarding to embrace value-driven principles in traditional Medicare. Introduction Ever since the Affordable Care Act (ACA) became the law of the land in
Roadmap to Innovation: What Payers Need to Compete in the Digital-First Healthcare Environment
Innovation is no longer optional for established health payers and digital native startups. Without revamping inefficient processes, payers risk falling behind in the race for provider participating providers and market share.Here are the first steps payers can take on the path toward sustainable, successful innovation. Introduction The health plan marketplace is evolving quickly as changing demographics, new regulations,
Keep your Medicare Advantage network build on track with these tips
As fall settles in, and you’re sitting at your (home office) desk with a pumpkin spice latte, chances are your organization is well into its Medicare Advantage provider network builds. Network builds are such large projects, with so many moving parts, that it can be difficult to truly understand how well a project is progressing. If you’re not able to
Turning an Early “No” in a Medicare Advantage Network to Your Advantage
No one starts a Medicare Advantage (MA) network development project with the idea of pulling the plug before it’s approved by CMS. With the continued growth of Medicare Advantage, abandoning a build that’s in-progress could easily feel like a fruitless exercise. But that doesn’t have to be the case. Health Plans, and specifically their network development teams, can often learn
Infusing Digital Innovation into Network Development to Boost Efficiency and Improve Experiences
View PDF version High-performing provider networks are at the core of a health plan’s success. Embracing digital innovation during the network development process will allow Medicare Advantage plans to secure the best possible partners in an extremely competitive environment. The Medicare Advantage (MA) marketplace has never been more vibrant. More Americans than ever are opting for the affordable coverage and
Credential Your Network While You Build It
Both network builds and credentialing rely on having accurate, up-to-date data. Consider integrating these two processes around a unified data resource to deliver the best results while saving time and money.
Why a holistic approach to Medicare Advantage makes all the difference
The facts and figures behind the growth of Medicare Advantage (MA) are clear – Medicare Advantage patients pay 40% less out-of-pocket on healthcare compared to patients in traditional fee-for-service Medicare plans. Combine that with ancillary benefits like hearing aids, vision care, and dental care, it’s no surprise that patients find MA plans appealing. And that appeal is resulting in substantial
Redefine the Provider Network Development Process with Technology
Let’s get real for a second. Working in the healthcare industry is rewarding but can be frustrating at times. Providers and patients alike look to healthcare organizations to offer easy-to-use, modern solutions that make their experience as seamless as possible. Yet the healthcare industry as a whole is playing catchup on back-end innovations that can make our own processes faster,
The Top 5 Mistakes You’re Making in Your Provider Network Development Strategy
Launching a provider network is a complex process requiring the coordination of multiple teams and countless data points. Even for experienced healthcare organizations, the work it takes to establish or expand a plan is almost too much to handle alone, especially without the proper tools. Having worked in the healthcare industry for years and collaborated on the launch of dozens
