How Strategic Provider Network Management Lowers Healthcare Costs

Technology has helped to improve productivity in nearly every industry over the last several decades. But one industry remains far behind: healthcare. In 2019, the United States spent an estimated $950 billion on nonclinical, administrative healthcare tasks, including provider network management. In the years since, this number has only increased.

Today, an estimated 15-30% of healthcare expenditures in the US are the direct result of administrative costs. But how many of these expenditures are unnecessary? Which ones can be simplified?

The fee-for-service payment model that dominates healthcare in the US works to enable innovation in the field, but it also puts significant administrative strain on providers and other healthcare teams. In addition to delivering high-quality care, health systems have to use valuable time and resources to manage multiple transaction and communication points that make that care possible. Keeping physician credentials up to date and network monitoring also contribute to this administrative burden and unnecessary spending. One review using data from 2012 to 2019 found that the estimated cost of waste in the US healthcare system ranged from $760 to $935 billion.

Research suggests that simplifying healthcare administration could save up to $265 billion across the industry. But how can insurers, digital health companies, providers, and health systems reduce overhead? One possible solution lies in healthcare provider data management. Here’s how this intervention could offer significant cost savings and help streamline healthcare administration.

Consolidate Data Into One Accurate Database

Every year, hospitals, providers, and insurers spend more than $2.1 billion on inefficient and redundant tasks in effort to maintain provider data. Ensuring accurate provider data is crucial to performing essential business functions. But without a central database to store credentialing, contracts, practice profiles, and other provider-related data, it can come at a high price.

A healthcare provider data management solution can help to alleviate this burden. By consolidating all data (including credentialing, enrollment, and licensing workflows) into one convenient source, teams can reduce time spent on duplicate tasks so that they can work smarter and more efficiently while spending less effort on data collection and maintenance.

Streamline Payer Enrollment and Provider Credentialing

Healthcare payers and providers spend an estimated $496 billion on billing and insurance-related costs each year. These costs include payer enrollment, claims submission, claims reconciliation, and payment processing, among others. An additional estimated $2.76 billion is spent on maintaining provider data, according to the Council for Affordable Quality Healthcare (CAQH).

But one report found that intelligent payer operations, including provider network management systems that automate payer enrollment and provider credentialing, could significantly increase productivity, revenue, and quality for healthcare payers and providers.

Using the same automated provider network management system to enroll payers and automate provider credentialing enables faster and easier reimbursements. This reduces financial administrative burden and helps teams get back to providing optimal care.

Offer Real-Time and Reliable Risk Mitigation

With the expansion of healthcare technologies and telehealth services, risk management has become even more complex in recent years. In addition to monitoring patient safety and protecting against financial liability, healthcare organizations must now monitor cybersecurity concerns as well as the industry’s constantly evolving legal, political, and reimbursement climate.

Though healthcare systems are aware of the significance of expanding and modernizing their risk management approach, many providers and other organizations have been slow to implement more sophisticated programs. But an automated network management system could again prove essential to meeting the industry’s changing administrative needs. 

Using a provider intelligence platform that consolidates data, streamlines payer enrollment and provider credentialing and offers real-time network monitoring could help to bring your organization’s risk management into the 21st century, making fines and public relations crises a thing of the past. What’s more, finding a service that flags real-time changes to providers’ data could also help to avoid compliance issues including government sanctions and state licensure actions.

Empower Healthcare Teams

Burnout rates are at an all-time high among healthcare professionals, including providers, administrators, and executives. Since the emergence of COVID-19 in 2020, healthcare workers in the US have faced unprecedented challenges in continuing to provide their communities with access to care.

Though the height of the global public health crisis has passed, organizations are still struggling with how to optimize their workflows to meet new industry standards. Using a healthcare provider data management solution can help to empower teams to build and manage their networks to suit their unique needs. With actionable provider intelligence and a comprehensive, end-to-end network management solution, healthcare teams can use automated provider network management services to get their bandwidth back so they can focus on strategies that improve workflows and efficiency.

How Certify Can Help

It’s clear that the future of healthcare is digital. Since the pandemic began, virtual care utilization has stabilized at levels 38 times higher than before the emergence of the virus. Consumer and provider attitudes toward telehealth and virtual care have also improved as business models continue to search for broader virtual health solutions, including those that can optimize operational requirements—like provider licensing and payer enrollment obstacles that can block a business’ growth. 

Enter Certify. Certify is a first-of-its-kind provider intelligence platform that delivers frictionless, API-first credentialing, licensing, enrollment, and network monitoring to health insurers, healthcare provider groups, health systems, and digital health companies. Our end-to-end solution leverages one easy-to-use platform that gives your team direct access to hundreds of curated data points and insights, so you can manage your provider network efficiently, effectively, and at scale.

For stakeholders across the healthcare system, Certify drives incredible performance:

• 40% decrease in credentialing expenses for health insurers
• 95% less administrative coordination for provider groups
• 50% faster time to in-network participation for providers and provider groups
• 80% less paperwork for providers

Reach out to a member of the Certify team to learn how we can help you reduce administrative burdens and scale operations or request a live demo.