The Future of Healthcare: Provider Management Is Critical

June 27, 2013
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Provider Management.  New term – maybe. New business – no.

Provider Management is a unique niche within healthcare that is only recently gaining steam as its impact on the broader healthcare landscape becomes apparent.  

Provider Management.  New term – maybe. New business – no.

Provider Management is a unique niche within healthcare that is only recently gaining steam as its impact on the broader healthcare landscape becomes apparent.  

I began my professional career as a Human Capital Consultant – playing multiple roles on global projects focused on Human Resource process improvement, outsourcing, technology implementation, change management, and workforce planning. All of the projects I was involved in, inherently, tied to the notion of Human Capital Management; the strategic approach and processes associated with effectively managing your organization’s most important resource – people. Human Capital Management often includes, but is not limited to:

      • Recruitment
      • Talent Management (succession planning, performance management, etc.)
      • Human Resource Management (benefits, workforce planning, etc.)
      • Payroll Administration
      • Time Tracking

healthcare provider managementWhat’s intriguing is that the standard approach to this process works in most, but not all industries. One industry that introduces complexity is healthcare. Within healthcare, you have a defined set of resources – Providers – that have a truly unique set of requirements to effectively become members of the staff and help drive some of the long-term outcomes the organization desires – engagement, revenue, and successful patient outcomes through the delivery of high quality patient care.

This reality requires a unique solution to complement the standard Human Capital Management approach.

Enter Provider Management

Provider Management is when your organization leverages fully integrated technology-enabled services, coupled with modernized processes and consolidated business practices, to transform the way you manage providers. This allows organizations to more effectively unify and improve the continuum of activities that establish and maintain the working relationship between providers, health systems, and payers.  This removes inefficiency, redundancy, and decentralization that often plagues health systems. Some of the specific components of Provider Management that differ from Human Capital management are the following:

      • Credentialing
      • Privileging
      • Appointment
      • Payer Enrollment
      • FPPE/OPPE
      • Quality Improvement
      • Risk Management
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The unique components of Provider Management ultimately roll into the broader Human Capital Management at your organization. However, it is critical to have the correct processes and technology to ensure alignment to the appropriate regulations, bylaws, and desired organizational outcomes.

When Provider Management solutions are successfully incorporated into the strategy of healthcare organizations, the following outcomes can be achieved:

      • Streamlined Onboarding Process
      • Optimized Revenue Management
      • Minimized Bad Debt from Payer Enrollment Gaps
      • Reduced Administrative Redundancy
      • Improved Provider Engagement and Retention
      • Simplified Compliance Reporting
      • Objective, Transparent, and Standardized Performance Evaluation and Peer Review Processes
      • Proactive Risk Management

Organizations continue to address recent changes in the healthcare industry through dedicated projects such as facility consolidation, EMR Implementation, ICD-10 conversion, and patient safety and quality improvement. These are all significant and critically important efforts. However, often overlooked is the impact a streamlined and state of the art Provider Management approach can have on the organization and in driving the tangential benefits of the aforementioned projects. Take the time now to assess whether you are achieving the best possible outcomes. 

(healthcare provider management / shutterstock)