Did you know that healthcare organizations spend billions of dollars on administrative and non-clinical tasks, of which payer-provider collaborations are a huge percentage?
A provider network management (PNM) system solves this issue and many others by simplifying provider recruitment, credentialing, contracting, claims, and service.
The right PNM solution can transform how you manage your provider network, streamlining processes, improving compliance, and enhancing provider satisfaction. In a survey by Bain & Company and KLAS Research, 56% of healthcare provider executives cited software and technology as one of their top three strategic priorities.
But how can you choose the ideal PNM solution that meets your healthcare system’s needs?
This article will help you. Let’s get started already.
12 Things to Consider When Choosing a Provider Network Management Solution
Choosing the ideal healthcare provider network management software for your practice may be difficult because of the many factors to consider and the numerous options available in the market.
To make an informed decision, you'll need to compare and evaluate different healthcare PNM software and decide the best fit for your practice.
Here are the questions to ask when comparing and evaluating PNM software:
1. What key features should a provider network management solution include?
A good PNM solution should be your one-stop shop for managing providers. Look out for these features:
- Licensing, Credentialing, and Enrollment: You need a solution that automates the manual and recurring tasks involved in licensing, credentialing, and enrollment. Choose a software that encompasses these features. With such software, hospitals have reported a 20% reduction in credentialing timelines and a 50% reduction in committee review meetings.
- Data Management and Analytics: Ever tried to pull a report from multiple systems? It’s a nightmare. A good PNM solution should centralize your data, giving you insights on a single dashboard. Choose a secure, privacy-compliant solution to ensure optimum data protection and prevent breaches.
- Roster Management: Choose a solution that allows you to automate roster creation, track provider status changes and foster digital transformation in provider network management.
- Compliance Support: With healthcare regulations constantly changing, keeping up can feel like running on a treadmill. The right solution should include built-in compliance tools to help you stay up-to-date with regulatory requirements. For example, Assured provides real-time network monitoring to ensure your provider network is always compliant, valid, and current. This proactive monitoring is to make sure your provider network is compliant and audit-ready at any moment.
- Provider Enrollment Management: Prioritize solutions that offer multi-payer enrollment by providing a centralized management of enrollment processes across multiple insurance plans.
- PECOS Integration: Look out for direct submission capabilities to Medicare's Provider Enrollment, Chain, and Ownership System.
- Enrollment Tracking: You need real-time status updates on all pending enrollments.
- Document Management: There should be a centralized storage and management of enrollment-related documents.
2. How easily can the PNM integrate with our existing systems?
You’ve probably experienced the headache of systems that just don’t work together. So you must ask this valid question to ensure smooth workflows. A few things to consider:
- System Compatibility: Does your PNM solution integrate with your electronic health record (EHR), billing, ATS, EMR, and Salesforce. If not, you’re looking at manual data entry—and a lot of it.
- Interoperability: A 2022 report found 75% of healthcare organizations prioritize interoperability when choosing a new system. The solution should support interoperability, ensuring smooth data migration and minimal disruption to current operations.
This simply means that you should look for solutions that allow you to analyze and manage data across all provider records, research, and operations databases to enable faster and smarter data-driven decisions that will promote healthcare.
- Integration Capabilities:
- API Availability: Check if the solution offers robust APIs for seamless integration with your existing and future systems.
- Third-party Integrations: The ability to connect with other healthcare tools and databases can significantly enhance the solution's value.
3. Is the solution user-friendly and easily automated?
Ever had to train staff on a new system, only to have them revert to old methods? That’s what happens when a system isn’t user-friendly:
- User-Friendliness: Look for a solution that your team will actually want to use. Easy-to-use PNM solutions will lead to increased employee usage, ensuring that the benefits of the solution are fully utilized. When users can self-discover the tool, there will be little to no need for robust employee training programs.
- Automation Capabilities: Automation isn’t just a buzzword—it’s a game-changer. Think of all the hours spent on manual processes that could be automated, freeing up your staff for more critical tasks. They can create workflows, automate their routine processes, and ensure that network management is automated in all ways possible.
- Training and Support: No one likes being left in the dark. Make sure your vendor offers comprehensive training and ongoing support for employees to properly use the software.
4. What are the total costs associated with implementing the solution?
Let’s be honest—budget is always a concern. But it’s not just about the displayed price; sometimes, there are usually hidden costs that you may not know about until you start using the software.
- Total Cost of Ownership: Beyond the initial cost, consider what you’ll be paying for maintenance, updates, and any hidden fees. So you must find out if there are any hidden fees or ongoing maintenance costs. Research showed that unexpected maintenance costs add a great percentage to the total cost of ownership which is usually about 15-20% for many healthcare systems.
5. How does the solution help reduce operational costs?
A good PNM solution should pay for itself in no time. Look for one that helps you cut down on operational costs through efficiencies and automation.
First, when most of the manual tasks are taken care of by automation, the employee burnout rate is decreased, hence increasing productivity which yields more revenue.
Administrative and operational difficulties are also reduced and you save on costs you would have spent due to those difficult tasks.
6. What security measures are in place to protect sensitive provider data?
In healthcare, there’s no such thing as being too careful with data. So, pay attention to solutions that offer these:
- Regulatory Compliance: According to a Ponemon Institute study, the average cost of a breach for a healthcare organization is approximately $4.8 million, and trending upwards. Your PNM solution should help you stay compliant and avoid costly penalties.
- Data Security Measures: With data breaches on the rise, security is non-negotiable. Look for features like encryption, multi-factor authentication, and regular security audits.
- Regular Updates: The world of healthcare regulations is ever-changing. Choose a solution that is up to date with trends, ensuring your data is always secure and compliant.
7. What is the vendor's reputation in the healthcare industry?
You don’t want a solution you cannot vouch for. Before purchasing, check for:
- Vendor Track Record: Ask for case studies and testimonials. If other healthcare systems are happy with the performance and reliability, that’s a good sign.
- System Downtime Management: Downtimes are bound to happen. But, you don’t want a vendor that will leave you to figure it out when it does. How does the vendor handle system downtimes? A reputable vendor will already have a solid plan in place to minimize disruptions.
8. Can the PNM solution be tailored to your organization?
Your healthcare system is dynamic, and constantly evolving to meet new challenges and opportunities. Your PNM solution should be equally adaptable, growing, and changing alongside your organization with minimal disruptions. When evaluating PNM solutions, consider the following aspects:
Customization Options:
- Workflow Customization: Look for solutions that allow you to tailor workflows to match your specific processes and organizational structure.
- Custom Fields and Forms: Ensure the system can accommodate unique data fields or forms that your organization requires.
- Reporting Flexibility: The ability to create custom reports and dashboards is crucial for extracting relevant insights.
Scalability:
- User Scalability: As your provider network expands, the solution should easily accommodate more users without performance degradation.
- Data Volume Handling: Ensure the system can manage increasing data volumes efficiently.
- Feature Scalability: Look for solutions that offer tiered features, allowing you to activate advanced functionalities as your needs grow.
Scaling Timeline:
- Quick Deployment: Consider solutions that offer rapid scaling. For instance, while manual scaling might take 6-12 months, advanced solutions like Assured can help you scale up or down in as little as one month.
- Phased Implementation: Look for vendors that offer a phased approach to scaling, allowing you to prioritize critical features and gradually expand.
9. Is the PNM solution agile and up-to-date with trends?
A PNM solution has to be agile enough to evolve with trends and future changes.
- Regular Updates: Choose a solution that receives frequent updates to stay aligned with industry trends and regulatory changes.
- Emerging Technology Support: Consider if the solution is prepared to incorporate emerging technologies like AI or blockchain in the future.
10. What kind of customer support does the vendor provide?
You’re not just buying a product—you’re entering a partnership. The vendor must be willing to support you and your team every step of the way. Here are a few things to look out for:
- Customer Support: When something goes wrong, you want help fast. Ensure your vendor offers holistic customer support; 24/7 technical support, account managers, training resources, and user community forums
- Vendor Support During Transition: Transition periods can be bumpy. A good vendor will offer strong support to help you through it. From data migration help to scaling options and help
11. How does the solution encourage provider engagement?
- Comprehensive Communication Tools:
This includes:
- Multi-channel Messaging: Look for solutions offering diverse communication channels (email, SMS, in-app notifications) to reach providers effectively.
- Targeted Outreach: Ability to segment providers and send tailored communications based on specialties, locations, or other criteria.
- Automated Notifications: System-generated alerts for important updates, deadlines, or required actions.
- Two-way Communication: Platforms that allow providers to easily respond or initiate conversations with your team.
- Robust Self-Service Capabilities:
- Provider Portal: A user-friendly interface where providers can access and manage their information 24/7.
- Profile Management: Tools for providers to update their demographic information, practice details, and professional credentials.
- Document Upload: Secure mechanisms for providers to submit and update required documentation.
- Application Tracking: Real-time status updates on credentialing and enrollment processes.
- Appointment Availability: Features allowing providers to update their availability for appointments.
- Performance Analytics and Feedback:
- Provider Scorecards: Transparent sharing of performance metrics with providers.
- Satisfaction Surveys: Built-in tools to regularly gather and analyze provider feedback.
- Benchmarking: Ability for providers to see how they compare to peers in key metrics.
- Educational Resources:
- Knowledge Base: A centralized repository of FAQs, guides, and best practices.
- Training Modules: Interactive online training sessions on using the PNM system effectively.
- Regulatory Updates: Easy access to the latest industry regulations and compliance requirements.
- Collaborative Tools:
- Peer Networking: Features that facilitate provider-to-provider communication and collaboration.
- Virtual Meetings: Built-in video conferencing for remote consultations or network meetings.
- Shared Calendars: Tools for coordinating schedules and managing network events.
12. How does the PNM solution manage the enrollment process with multiple payers, each with different requirements and timelines?
One of the most challenging aspects of managing a provider network is the enrollment process, particularly when dealing with multiple payers.
Each payer—be it private insurers, Medicare, or Medicaid—has its own set of requirements, forms, and timelines for enrolling providers. If not managed efficiently, this complexity can lead to delays, errors, and frustration for both providers and your administrative staff.
Look out for a PNM solution that centralizes payer requirements, making it easy to scan through requirements and speed up the enrollment process.
Overall an ideal PNM solution should process multiple applications in parallel. Eliminating the bottlenecks of sequential handling and enabling your organization to scale easily.
Not sure which PNM solution to choose? Keep reading.
Choose Assured for Effective Healthcare Provider Network Management
Choosing the right Provider Network Management solution isn’t just a box to tick—it’s a strategic decision that can significantly impact your healthcare system’s efficiency, cost-effectiveness, and provider satisfaction.
Assured is our platform, proven and trusted to meet the above criteria. The Assured platform automates the process of credentialing, licensing, enrollment, and network management. The centralized platform simplifies accessing, managing, and processing provider network data at scale.
Assured has helped healthcare systems streamline their provider networks. Quinn Donaldson, head of operations at Birches Health said that Assured’s deep insurance network expertise allowed them to open several markets simultaneously, and do so while increasing access to affordable care.
In his words: “Our work with them has helped accelerate growth, and been paramount in helping us keep patient and provider experiences high.”
Want to see how Assured can help your organization? Get in touch and let’s start the conversation.
