Achieve your Provider Network Optimization goals with Presscott Associates’ approach and services offered to our health plan clients!

PROVIDER NETWORK OPTIMIZATION

We add the value of economics to the assurance of healthcare.

As provider networks have evolved, health plans have been able to distinguish their health insurance offerings by:

Improving customer service to their membership
Promoting robust and efficient/effective healthcare delivery provider networks

The essential formula for success is to maintain and, at the same time, continue to improve upon the provider network’s attributes.

You can expect Presscott Associates to optimize your provider network and assist your organization as follows:

Strategic Analysis

Analyze market demographics, managed care penetration, financing trends, consumer needs and the nature of your competition to identify opportunities and recommend future strategies/tactics
Identify physician network improvements/opportunities:

– “Right Doctor” analyses
– Specialty-specific medical cost trends relative to industry benchmarks
– Physician tiering strategies
– Competitive assessments and related recruitment approaches (see Strategic Relationship
Management)

Assess out-of-network utilization and policy consistency/compliance (see Medical Expense Management)
Develop alternative models of provider reimbursement (see Economic Value Analysis) to more closely align incentives with key caregivers
Analyze the alignment between medical policy and claims administration to ascertain medical policy compliance levels and opportunities for improvement

Operational Support

Develop and implement programs to foster and motivate providers to use a health plan’s website provider portal:

– Pre-authorizations/referrals
– Member eligibility
– Claim status and electronic payments
– Policy and procedure updates

Review the inter-departmental linkages involved in provider contract management activities to ensure an efficient and accurate flow of information for optimal contract compliance performance:

– Provider Operations, including provider communications and contract loading
– Actuarial Services
– Information Technology
– Claims
– Medical Management

Achieve your Provider Network Optimization goals with Presscott Associates’ approach and services offered to our health plan clients!

“Successful Transition to Electronic Referrals: Training and Motivating Providers to Achieve Health Plan Savings and Provider Satisfaction”