The Provider Network Revolution: Can an Alliance consortium accelerate your innovations?

Wednesday, 5/5/2021
10:30 AM CT – 11:30 AM CT (60 minutes)

As health plans, we care a LOT about our provider networks.  

And it makes sense. On most days, for most of your members, the provider network IS the health plan. 80% or more of your health plan dollars are paid to your network providers. And – other than your members – network providers are your health plan’s most important constituency.  Your network providers drive more of your quality scores, not to mention member satisfaction and retention, than any other part of your health plan … And your network issues draw member complaints, unflattering media and regulatory attention.

We also know that government actions will force networks to change. 

• CMS is implementing the Interoperability regulation, with enforcement beginning July 1: National API standard for Medicaid and Medicare Advantage directories forms the basis for a national “source of truth” on provider information
• The No Surprises Act has a surprising provision: Commercial plans must have a regularly verified public provider database and plans will be liable when members go to Out of Network (OON) providers because of a directory error
• States are undertaking interesting experiments, among them: California’s provider network utility (a statewide information depot for provider info); New Hampshire to use All Payer Claims Database to assess network adequacy; Louisiana Medicaid assigning points to MCOs for directory accuracy improvement
• The Biden administration will be more active in protecting consumers and will be looking at: Network adequacy – are there enough providers to meet member needs? And Network accuracy – do directories accurately reflect actual plan network?
  

In the next few years, data will exist to measure year-over-year provider network stability and link individual provider quality measures to a network’s overall quality.

Health Plans are making enormous strides in many areas …

• Market Expansion
• Provider Contracts
• Provider Outreach and Training
• Provider Network Quality
• Provider Network Compliance 
• Value Based Reimbursement Methodologies
• Developing a High-Performance Network - Network Tiering Strategy and High Value Provider Programs
• Integrating Telehealth Providers into Network Management

… But no Health Plan is making enormous strides in ALL of these areas.  Our ability to innovate our networks is limited by inertia and distrust, provider contracting norms and opportunity cost.

Can Alliance members overcome these limiters through a consortium model? 

Via the Alliance, non-competing plans can accomplish more.  Expert-led sessions combine with peer-to-peer learning to maximize value. The purpose of this call is to explore the possibility of launching a focused program that accelerates your innovation and helps you leap frog in your market.  We will explore this hypothesis together and identify what such a program could look like: What are the areas of focus? How many weeks should it last? Who should be a part of it? What outcomes do we want? What deliverables should we create?

Audience

Health Plan leaders with responsibility for their health plan’s provider network strategy and design. If you’re wrestling with any of these issues, this call is for you! We believe this call will be of particular interest to:

• Provider relations and others with responsibility for building and improving your provider network
• Chief Medical Officers
• Care management and quality leaders
• Legal and Compliance leaders
• Product development leaders
• Partners within your provider system owner/provider partner organizations with responsibility for system strategy

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