The impact of unnecessary or redundant administrative processes related to provider network integrity creates a snowball effect that is shared across the entire health plan organization. This incurs decreased revenue and increased expense line items within departments such as IT, network management, claims management, risk adjustment, and more. For example, a mid-sized health plan with 3 million members could potentially be at risk for more than $100M in lost revenue and compliance penalties—in a single plan year, according to a study by HealthScape Advisors.
Underlying issues related to staff burnout and turnover contribute to the snowball effect as more burden is placed on team members, when their colleagues resign. This opens the door to errors, more inefficiencies, and more resignations which contribute to a higher cost of doing business. Health plans and Workers’ Compensation organizations can no longer accept this as the “normal cost of doing business.” Keeping on the same path makes maintaining provider network integrity virtually impossible and increasingly costly.
Organizations must determine what role their current provider network management processes may be impacting the burden on staff. They need to take a brutal look at how inefficiencies in back-office operations impact both the visible and hidden costs of maintaining provider network integrity. Only in doing so, can they identify opportunities for automation and outsourcing that can contribute to help to improve member loyalty and satisfaction, lower costs related to risk and inefficiencies, and lead to less burden and greater work-life balance for their teams.