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 benefits that MA plans can offer, with a record 26 million enrollees in 2021.

Payers are capitalizing on this interest by developing more than 3,500 different MA plans across the nation, giving the average beneficiary over 30 options to choose from.

As millions of Americans know, trying to determine the right health plan as a prospective member can be a dizzying task. What fewer know is that it’s also challenging for healthcare providers looking to find the right network to…

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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.

 

The health plan marketplace is evolving quickly as changing demographics, new regulations, and cutting-edge technologies sweep away the status quo. Both commercial health plans and Medicare Advantage (MA) plans are seeing increased competition for visibility and market share, especially as consumers become more and more savvy about their preferences and needs.

But are internal health plan operations innovating at the same rate? Unfortunately for many payers, the answer is “no.”

Even as an emerging class of fresh-faced, digital-first payers and direct-to-consumer (DTC) telehealth companies rises up to challenge the notion of business as usual, a worrying number of payers are still relying on manual processes and fragmented workflows for network development and maintenance. As a result, they are missing out on key opportunities and creating frustration for internal stakeholders and their external partners.

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