Provider Network Management Resources

Take deep dives into provider network management news, best practices, and technology with expert members of the andros team.

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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

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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

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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

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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

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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

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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,

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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

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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

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Infusing Digital Innovation into Network Development to Boost Efficiency and Improve Experiences

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.   Introduction The Medicare Advantage (MA) marketplace has never been more vibrant. More Americans than ever are opting for the affordable coverage and enhanced

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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

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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,

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