The United States healthcare ecosystem is remarkably complex. With providers, payers, regulators and vendors at play, provider data is collected and stored separately leading to inaccuracies and inefficiencies.
While other industries have implemented more consumer-friendly practices, many healthcare companies are clinging to legacy systems despite the pain points this causes for patients, payers and providers. Valuable work hours are spent maintaining these systems – costing not only companies, but also their customers.
Legacy systems and their limits on financial and data transactions leads to a variety of patient pain points –from filling out the same paper across different parts of the patient journey, trying to resolve a financial issue between a payer and provider or waiting on prior authorization before having a procedure. This will continue to prevent organizations from providing the best patient care and experience. Cloud based systems are more cost efficient and support a wide variety of partner programs – resulting in that crucial data integration.
Transitioning Provider Network Management systems to the cloud helps to eliminate data gaps, error-prone provider directories, inaccurate claims payment, costly rework cycles and poor member service caused by legacy systems. Yet, many organizations are continuing with the status quo as the transition seems too costly or complicated to be worthwhile.
However according to, McKinsey & Company, cloud capabilities have the potential to generate value of $100 billion to $170 billion in 2023 for healthcare companies. So, what do companies need to know as they consider transitioning their legacy systems to provide a better patient experience, improve health outcomes and eliminate administrative waste?
Automation Helps to Consolidates Data and Administrative Efforts:
With built in provider data checks and ongoing exclusion monitoring, cloud-based systems monitor for changes, alert organizations in real-time and ensure provider data is up to date. For example, the Virsys12 Provider Data Engine keeps health plans compliant by automatically updating provider directories with the most recent information.
In addition to provider data, other cloud-based technologies can support better patient data–from care plans and lab results to authorizations and medical claims. Further reducing administrative burdens, secure alerts can be sent to patients regarding their appointment information or claim status. These automations save organizations in the long run and free up provider hours for improved patient care.
Integrated Systems Provide Strategic Insights
Improved access to data in real time offers enhanced insights into patient behavior and needs, benefiting all parties.
Providers gain access to information on how new patients are finding their practice allowing them to reallocate marketing dollars where they will be most effective. They can also gain further understanding of their reimbursement procedures, increase their understanding of how their pricing could be more competitive, and how best to optimize their interactions with insurance payers to ensure proper rate negotiations are occurring.
Payers gain insights on the claim submission process, such as what physician offices are providing which services and solutions. They also gain data on patient behaviors and needs. This allows them to implement strategies that increase member retention. Providers can use similar data to design more effective care management processes.
By analyzing the market and network data, all parties can identify areas of opportunity for expansion.
Analytics Capabilities allow for Informed Decision Making
Cloud-based platforms eliminate costly mistakes and manual effort, but when decisions must be made, they also provide analytics that can be used to quickly inform company leaders as they make important choices that impact the many patients they interact with each day.
Quantitative and statistical analysis tools are used alongside a variety of predictive models. This enables organizations to make critical decisions based on real time data and visualizations – preventing delays and costly mistakes.
With the benefits of automation, strategic insights and informed decision making, it’s easy to understand why the healthcare industry is talking about cloud-based provider network management. As networks grow more complex and government mandates call for the industry to improve their organizational efficiency, reduce operation costs, improve benefits coverage, and improve customer satisfaction benchmarks, switching to cloud provider network management will become increasingly important.
While the transition is complex, choosing a partner that has experience with both providers and payers, understands an organization’s goals and mission to build a customized strategy and provides leadership, implementation and ongoing management and services will ease the process. The end result? Better and more efficient care in every aspect of the patient journey.