Kate Farley-Agee
Vice President, Network Product Management
Payers are looking for network management partners with innovative strategies to control rising medical costs, provide adequate coverage, quality of care, and streamline workflows to increase efficiencies. At Enlyte, we're leading the charge with our revolutionary approach to network management.
Contracting Strategy: Maximizing Value through Strategic Negotiations
One of the foundations of effective network management is a robust contracting strategy. Securing favorable rates is an essential focus for both renegotiations and new provider agreements. By strategically aligning our contracting processes, we strive for optimal coverage both nationally and regionally, while delivering competitive savings and high-quality care.
Understanding the health care market at a state level is also essential to choosing high quality providers and strategic recruiting of providers and hospitals. The supply in the market, how the referral patterns move in the market and if there are specific state or regional factors which will affect the recruitment and retention of providers in the market.
Implementing a comprehensive credentialing program, such as URAC or NCQA, further enhances provider quality. These programs not only verify the qualifications of providers, but also build a foundation of trust and reliability within the network.
Provider Engagement: Building Strong Relationships
Engaging with providers is about more than just contracts; it’s about building lasting relationships through education, engagement, servicing and support. This helps providers feel valued and supported and removes administrative obstacles which in turn fosters loyalty and high-quality service delivery to patients.
Having a provider portal helps significantly enhance the recruitment process, improve information access, and increase overall provider satisfaction. A well-designed, self-service portal serves as a central hub where providers can easily find the resources they need, leading to a more streamlined and efficient operation that reduces provider noise to the payer.
We proactively build relationships with the most utilized providers. Each key provider is assigned a dedicated consultant. A single point of contact ensures consistency: provider questions are expedited, and every dialog generates a greater understanding of the unique challenges and opportunities within their practice. Quick and personalized resolutions of issues elevate the provider experience and reduce operational friction.
Network Management: Modernizing Networks
Unlike historical network management strategies, Coventry is focused on optimizing networks by prioritizing provider outcomes over network outcomes by leveraging data analytics to enhance savings for the payer.
A traditional network hierarchy includes a mix of providers that may result in the selection of a lesser performing contract. Through network modernization, the Coventry Integrated Network delivers a provider-based approach designed to leverage the most advantageous provider contract across all networks to achieve optimal outcomes. By utilizing advanced technologies, we identify the best provider and provide access to optimal discounts and treatment that the geographic location has to offer.
Improving processes for provider data validation is another critical area. Utilizing bill and clinical data allows for better data and updates loaded as quickly as possible. Accurate data is essential for effective network management, providing access to reliable and up-to-date information so that injured individuals get to the providers they need.
Regulatory and Compliance: Staying Ahead of Industry Changes
Enlyte actively participates in industry associations and legislative initiatives to not only stay updated on the latest developments, but also to contribute to discussions and initiatives to help shape the future, share knowledge and influence policies that impact the industry.
Expert audit and hearing support are essential services that help payers ensure compliance and uphold standards by identifying potential issues and implementing regulatory solutions. Services also include expert testimony in legislative matters and litigation support.
Data Analytics: Driving Insights and Improving Outcomes
Integrating AI with our wealth of data supports automation initiatives, creates efficiencies and supports accuracy. Analytic support for negotiations helps improve rates, monitor performance and impactful savings. By leveraging casualty-focused systems for data collection, contract and rate administration ensures that our network operates at peak performance.
Ongoing data monitoring is crucial for reducing errors and improving repricing. Continuous oversight and analysis help maintain the integrity of our network, ensuring optimal outcomes for all parties involved.
Effecting Outcomes through Innovation and Investments
Coventry’s innovations and investments are modernizing network management in the property and casualty industry, leading to better outcomes for all stakeholders. By prioritizing strategic contracting, engaging providers effectively, and utilizing AI and data analytics, we help improve efficiencies, increase access to quality care, reduce medical costs, and drive substantial savings.