Provider Network Management Resources
Take deep dives into provider network management news, best practices, and technology with expert members of the andros team.
As healthcare advances and becomes more complex, compliance isn’t mere protocol—it’s the cornerstone of trust, bridging patient care and the intricate workings of organizational operations. Think of it not just as a rulebook, but as a silent sentinel, carefully preserving the integrity and security of healthcare practices against a backdrop of evolving standards and regulations. Fully understanding the nuanced relationship between
It’s no secret that access to healthcare services is a pivotal issue for many. Provider network adequacy, which ensures that health plans have enough providers to meet their members’ needs, serves as a cornerstone for healthcare access. However, the current network adequacy standards fall short in addressing how long patients may have to wait to get an appointment with their
When it comes to health plans, provider network adequacy is crucial. For most health insurance products, it is mandated by law that health insurers ensure that their networks are sufficient in size and scope to offer a defined set of covered services to their members. However, provider network adequacy does not always equate to actual member access. Fact or Myth?
When it comes to healthcare, ensuring the satisfaction and positive experience of patients or members should be a priority of networks. However, this seems not to be the case for some, particularly those that have inadequate provider networks. Contrary to what many people think, having a sufficient number of healthcare providers in a network does not necessarily mean that members
We’ve got you covered with a handy all-in-one guide to credentialing in 2023! The what, when, where, and how in one place. Fun fact – did you know this practice goes all the way back to 1000 BC? See how much you really know about credentialing. What Is Provider Credentialing In Healthcare? Provider credentialing, also known as practitioner credentialing, is the
In the ever-evolving landscape of healthcare, it’s not enough to just meet standards – you need to surpass them. As a health plan looking to outshine competitors, it’s crucial to understand that being merely ‘adequate’ won’t cut it. Your aim should be to offer an exceptional service that not only meets but exceeds the expectations of your consumers. That’s where
The healthcare industry may be thriving with new innovations in patient care, but provider network development often lacks the same innovative energy. This leads to a fractured and messy experience for providers, with over 70% of them unsatisfied with the contracting and credentialing experience.
To persuade them to join your network and reduce operating costs, treat every stage of the provider lifecycle as a unified experience. And that’s where andros comes in, managing the lifecycle of your providers in one place to build you a stronger network. With smart recruiting data and technology automation, you can attract new providers quickly and efficiently, and ensure that your network directory is error-free, complete, and compliant.
Plus, with automated full-time monitoring and compliance expertise, your provider network can maintain adequacy and compliance standards. By centralizing information and simplifying processes, andros helps you operate efficiently and serve your patients more effectively, ultimately making you more competitive in the healthcare marketplace.
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
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
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
“ 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
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
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
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
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
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
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? 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
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,