Article
Effective strategies for health plan network management
July 26, 2024 · Authored by Kevin Coonan, Heather L. Herc, Garrett Gosh
Health plan networks have experienced significant transformation in recent years, driven by trends in value-based care (VBC), regulatory changes and consumer expectations. Previously common place to broad preferred provider organizations (PPOs) and health maintenance organizations (HMOs), networks have now expanded include retail products, narrow networks, high-performing networks and government networks. This diversity demands specialized efforts in network construction, maintenance and data management.
To remain competitive and compliant, health plans must embrace comprehensive and adaptive strategies for successful network management, but it can be difficult to know where to begin.
Developing a comprehensive strategy
When navigating the complexities of health plan network management, health plans must develop a strategy that considers business enablement, operational readiness, technology and compliance. A robust work plan should align technical and data strategies with business objectives, ensuring that all aspects of network management are integrated and aligned.
Additionally, successful network management strategies involve comprehensive stakeholder engagement, including providers, internal audit teams and other key players. Educating stakeholders about network management processes and regulatory impacts fosters better collaboration and compliance. By bringing together systems, data and operational resources, health plans can help all stakeholders remain aligned and informed.
To navigate the complexities of health plan network management, consider the following strategies:
- Comprehensive data management: Implement robust data management systems capable of handling the vast amounts of data required for compliance with regulations like the No Surprises Act and Transparency in Coverage rules.
Health plans must handle vast amounts of data, ensuring its accuracy and accessibility. Implementing comprehensive data management systems helps meet regulatory requirements, improve decision-making and enhance overall operational efficiency. Advanced technologies and data analytics play a vital role in enhancing network adequacy, transparency and payment accuracy.
- Proactive regulatory compliance:
