Leveraging Provider Information for Efficient Network Management

"The surge in accountable care organizations and other network affiliations between healthcare providers is spelling big financial opportunity for hospital vice presidents of network development" - Healthcare Finance News

Trumpeted an article in Healthcare Finance News from 2015. The article was on target. Given the proliferation of Accountable Care and alternative value-based reimbursement mechanisms (“products”), the senior leader responsible for negotiating business relationships between their health care system, and independent primary care and specialty practices (“non-affiliated”), is the prow of the ship steering into a new era. An era of risk-sharing, with primary care (PCP) and specialty providers.

Patients refer to their Primary Care Physicians (PCP) for their specialty care and those patients may or may not be directed in network for their treatment. This presents a challenge for health system network management teams, charged with tracking the business coming from those physicians and building new partner relationships.

How are Network Management teams keeping track of provider network participation today?

Historically there has been no standardized method of tracking the impact of ACO’s, narrow networks and other provider affiliations on a health system’s business. EHR systems designed with patient data in mind have proven unreliable for maintenance of provider information and tracking referral volume. Health systems have resorted to tracking the information manually through spreadsheets, a time-consuming process requiring ongoing maintenance.

Phynd addresses the unique challenge of maintaining Provider Information. Supporting network management by helping them maintain full knowledge of each provider’s specialty, subspecialty, location, and all payor networks that each participates in.

Through Phynd, a Network Management team can start:

  • Managing which providers and locations – across an entire region – participate in specific ACOs, “narrow networks” and other ‘network’ affiliations.

  • Searching for and targeting new providers or practices to add to the health system’s network or other networks in which the health system participates.

  • Identifying holes in network coverage and filling those gaps to build up referral volume.

The health system will have access to comprehensive profiles for each provider, created from EHR and credentialing system extracts, updated with information from the Phynd National Provider Directory (NPD).

Accurate and current provider information is critical for the success of a health systems Network Management team. By tracking partners, their referrals and their affiliations, leaders will be better equipped to strategically build business and influence their referral champions.

We will be hosting a Web Clinic, Friday May 4th, with a focus on the topic of Network Management. It will be a great opportunity for those involved to learn how a more complete provider profile can impact growth efforts.