Take deep dives into credentialing, provider network management, and healthcare administration news, best practices, and technology with expert members of the andros team.
This fall, many health industry executives will be embarking on new jobs. Here are some of the biggest stories to know about: Doctor on Demand Makes New Executive Hires Doctor on Demand, a San Francisco-based startup that provides virtual care, recently announced two new hires. Robin Cherry Glass will now serve as President and Chief Commercial Officer, while David Deane
The autumn edition of our Healthcare Matters magazine discusses top trends that payers are wrestling with: How HIT Is Improving Administrative Efficiency Even though healthcare accounts for more than a sixth of the economy, most healthcare IT (HIT) developments have focused on the front end of healthcare— systems that are used by patients and providers. There has been relatively little
Executive Summary Provider data is the foundation of your business so being able to ensure that your data is useful (i.e., accurate) at the outset and then updated when it changes is invaluable. Bad data means any number of costly risks including fines, dysfunction for downstream processes like claims and business intelligence, and — as this open letter details — member dissatisfaction
CMS plays a critical role in establishing adequate standards for healthcare, especially for the underserved. This means that those who need care should be able to get it, when they need it, without unnecessary barriers preventing access to quality care. But how do those standards play out in real life? Download The PDF
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
An Accountable Care Provider (ACO) had multiple challenges, including missing growth targets, inability to collect or analyze recruitment data, and having slow recruitment processes. andros helped to educate providers, generate new revenue, and automate data collection, storage and analysis.
Celebrating #OneTeam: andros Fall MVPs Each quarter we acknowledge the team members who went above and beyond in their role and who exemplified the andros values. All MVP winners are nominated by their peers or manager and the People Team identifies the MVPs (and some honorable mentions!) for the quarter based on these nominations. We love this opportunity to recognize
One thing is well known – credentialing can be a long and arduous process. A possible solution to this problem is delegated credentialing, but many do not know where to start. While it might seem like a big undertaking, with the right preparation and partner, it can be a straightforward process. We’ve created an introduction to delegated credentialing breakdown so
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
When Humana began searching for a new CVO partner, they had clear criteria – their next vendor had to be a long-term solution to their problems. Our unique approach enabled Humana to proactively identify potential compliance issues and mitigate them before consequences arose.
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
As we progress through the 4th quarter of 2022 and start looking ahead to 2023, change is again in the air. We are committed to becoming ever-better partners to our customers. For me living that commitment means talking to our customers and in Late August I set a goal of meeting with 30 customers over 60 days — it’s been super rewarding.
A national health plan wanted to expand their Medicare Advantage (MA) offerings. Their goals were to offer new MA plans in two states with established product lines and launch MA plans in three new states. To achieve these goals in an acceptable time frame, the health plan needed every resource available. Unfortunately, they ran into a challenge: their internal network development team had no bandwidth due to other projects and the available resources on their commercial team did not have any experience with Medicare Advantage requirements.
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 Introduced in 1997 as Medicare+Choice, Medicare Advantage plans have three goals: Reduce costs Enhance quality of care Increase choice And they have. Leveraging the power of the healthcare market, Medicare Advantage has reduced costs to its members by about 40% a year compared to fee-for-service beneficiaries. Because it works, Medicare Advantage has grown consistently–and now its growth is accelerating.
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