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Healthcare Payer Solutions: Capture a Competitive Advantage with Streamlined Contracting

Authored by: i3 Healthcare Solutions 

Improving workflows, managing costs and keeping members happy are all critical goals for healthcare payers. Making improvements in these areas, however, isn’t always easy. And with growing competition and fast-moving market changes (we’re looking at you, inflation!), the need for optimization has never been stronger.  

It’s likely that you already use a network development and contracting (NDC) solution. But what most payers don’t realize is how targeted improvements in the software solutions you use can give you a stronger competitive advantage.  

We spoke with our internal gurus Jon Swisher, director of sales engineering at i3 Verticals, and Zach Tabor, director of software engineering at i3 Verticals, to discuss improvements they’ve captured by optimizing workflows, providing better member experiences, and working out some of the challenges that can hold payers back.  

Healthcare payer technology solutions: Building improvements based on real feedback  

When considering workflow improvements, Tabor is a big proponent of talking with customers to learn what processes are holding them back. He and his team did this before launching their recent NDC enhancements.  

“Product enhancements are important, so before we start, we listen to our customers,” says Tabor. “The last thing we want to do is say, ‘Oh, I think people need this feature, so let’s create it. We started with the feedback and let that guide the enhancements.”  

As Tabor’s team improved their existing NDC solution, they considered what customers said they needed in their workflows and what would make them more efficient. Then, they created changes to support that, helping customers work faster and more efficiently.  

Healthcare payer technology: Plugging productivity gaps  

With most NDC solutions, even the most minor process changes are time-consuming. “A change might not be completed for many weeks, so with our enhancements, we focused on putting the power back in the hands of users,” says Tabor.  

A few ways in which they accomplished this include:  

  • Administration and system settings: more accessible configuration options help speed up workflows and allow for changes to be made faster. Additionally, i3 Verticals added the ability to customize contract package generation. For example, you can prompt users on what documents to include in the package based on your user and business needs.  
  • Notification building: tabor heard from users that they wanted to see notification options when sending documents or communicating with an external party. So, the enhancements allowed users to customize messages and populate those notifications from the application itself.  
  • Creating contract templates: like notification templates, having the ability to develop a library of contract templates also provides an advantage. You don’t need to enter the data manually when a contract comes through. Also, internal reviews are expedited. For example, the reviewers are automatically assigned when a contract is created via template.  

Changes in the above areas help improve workflows, but another critical area to consider is creating a single source of truth. Because with it, you can marry speed to accuracy.  

Payer solutions healthcare: Creating a holistic view of data  

Entering data into systems multiple times isn’t only inefficient; it’s a potential risk. After all, the last thing that any payer wants is incorrect data flowing through their systems. As a result, you need a single source of truth.  This is even more true in today’s ecosystem of mergers and acquisitions, where you’re likely already struggling with multiple sources of truth. 

Many payers use provider data management (PDM) solutions to manage information, and even if you don’t, you still need a holistic view of information. “If you’re using a PDM, you can hook into our system to provide a holistic view of specific providers,” says Swisher. “And if you don’t, you can still use our system to view details about a provider more easily.”  

Pre-population capabilities are also critical as you consider accuracy, which is always a competitive advantage. “A solution that integrates to the NPI registry to repopulate data, for example, is helpful to speed up workflows and take some of that repetitive work off users’ plates,” says Swisher. “This is a feature that we offer, but many other solutions aren’t currently providing. So, make sure to ask about it when considering your options.”  

Healthcare payer solutions: Handling market “curve balls” with ease  

An NDC tool isn’t only about provider contracting. It’s about onboarding, management of existing contracts, renewals, and more. When you can capture greater efficiency across all these areas, you can recapture lost time, serve your members faster, and capture a competitive advantage that helps you easily navigate market curveballs.  

Learn more about how to capture a competitive advantage for your organization.

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