Provider Lifecycle Evolution, Part 2: Sustained Improvement

As plans get off the ground, we’ve noticed a few critical focus areas to keep squarely in your sights.

• Engage providers through reliable, easy to understand channels for recurring updates. Many plans mistakenly offer flexibility and numerous ways to engage but sacrifice clarity and structure that leads to success.
• Guide sequencing and architecture by mapping everywhere provider data is needed across your business. This sheds light on where your priorities are and helps keep you from trying to fix everything at once.
• Eliminate duplication for providers by keeping a laser focus on what distinguishes this request from all the rest. Providers engage when they see their work used – challenge yourself to minimize additional asks, but also to reduce frequency & breadth of data requests. Avoid the trap of trying to do everything at once – or asking them to do more “while you have them.” Focusing on the critical few builds a trusted relationship that makes it easy for them to keep coming back.

Simplified provider interaction differentiates you from the rest of the market, driving engagement and stronger offerings for the members that selected you.

The stick has been tried. It’s not working. We first thought directories would drive patients to providers, but they are not looking for better ways to increase business – the waiting rooms are full. Our providers don’t think they have a directory problem.

Make it about more than solving for directories. Engagement increases when accurate provider data leads to direct provider benefits:

• Faster claims adjudication
• Easier credentialing
• Reduced rework and fewer payment delays

“Stick-based” approaches have too many tradeoffs and risk hurting both sides in the long run. Find ways to unify against common problems and motivate for better ways of working.

For many health plans, this is a once in a career transformation. Take it from us that these tips and warnings made this list because we’ve seen them time and again. Learn from our experience and avoid these common pitfalls:

• Study your needs: from data structure and use cases to prioritization and executive ownership, the preparation is often more important than the execution. Set yourself up to succeed from the start.
• Provider Engagement is the most underestimated success factor: Health plans frequently overinvest in infrastructure while underinvesting in clear, valuable provider participation paths. There is no workaround for the provider.
• Build it for Both: Design your new system to respect the provider’s time, then make the most of their involvement.
• Pick an Industry Partner: Finally, pick a partner not blinded by the tech they’re comfortable with, but who truly understands what you need to do with the data. When they understand the larger goals and use cases, their advice is about outcomes, not tools.