Tracking Provider Health Plan Participation: An Urgent Need for Provider Information Tools

The explosion of health system-created and managed clinical networks and health plans has put tremendous pressure on teams to maintain accurate provider affiliation.

The typical provider accepts patients from over 20 health plans; the constantly-changing status of providers one day accepting, and then one day not accepting, patients from these plans has a substantial impact on patient satisfaction and appropriate referrals.

Compounding the challenge is the near-abdication of commercial health plans’ responsibility for maintaining accurate provider directories of their own plans. Phynd’s clients tell us that commercial plan managers call their health system partners’ network management and provider liaison teams to ask them which doctors are accepting or not accepting patients. And this standard operating procedure continues even after CMS imposed penalties on commercial payors in the wake of its own 2016 audit showing that over 50% of provider or information data in payor directories was inaccurate.

So health systems are doing the right thing – stepping into this massive provider information breach and owning health plan rosters.

The challenge is that without advanced provider information tools, the process of managing health plans is completely manual -- many hours and resources spent by senior network and health plans business analysts and managers to keep track of the information through spreadsheets/databases and to accurately pass along the details to the right Payers. Asking these skilled teams to keep track of thousands of providers’ affiliations to 20+ health plans is a recipe for inefficiency and low team morale.

Phynd’s latest version of its provider information management platform – version 3.2 – is an antidote for manual inefficient processes. IT provides:

  • Easy access view of all of your health plans from the dedicated tab or through your provider profiles

  • Powerful, easy-to-use tools to Manage Health Plan Details of both individual providers, locations, facilities and provider groups through new Health Plan menus

  • Comprehensive Health Plan profiles detailing affiliated providers and service locations

  • Organization capability – Group your Health Plans by Offering, Location, Structure

  • Campaign outreach tool to continuously update providers’ health plan patient acceptance status via digital email outreach and provider/delegate self-serve, so practice managers or office staff can update Phynd on a regular basis.

Phynd offers turn key service for, managing and leveraging provider information that is critical for meeting the demands of healthcare consumerism and value-base care initiatives. Maximizing the effectiveness of online provider search tools for both referring physicians and healthcare consumers is an investment that can quickly pay for itself by improving the effectiveness of physician referral and community outreach efforts.

The newly introduced Health Plan management functionality will give Health Systems a more complete picture of their provider population and their affiliations. With this new dimension of detail, Phynd clients will be able to improve network adequacy, track plan participation, and confidently support Payors with accurate provider details.

At the end of this month on August 28th at 1PM EST Phynd will be hosting a webinar where we will take a closer look at some specific processes that benefit from accurate health plan participation tracking.