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Payer Contracting: Why the Digital Era Requires a New Approach to Contracting

Authored by: Jon Swisher

Healthcare payers are navigating a challenging market, which includes shifting regulations, increased complexity, and fast-changing member expectations. As a result, the need for increased efficiency has never been greater. 

But achieving this efficiency isn’t always straightforward, especially in the digital age.  

 

As contracts become more complicated, employees often use manual workarounds, due to outdated systems and a lack of the diverse skill sets required for contracting. Together, these factors threaten productivity — and accuracy.  

 

Payer contracting is much easier when you have a system that effectively manages the entire life cycle — from start to finish — and helps you capitalize on new opportunities while improving efficiency and accuracy.  

Automated end-to-end payer contracting: How does it work?  

As you work to keep up in the digital age, the need for increased efficiency moves to the forefront, but how does automated end-to-end contracting help? 

 

It works by leveraging the pieces that make up contracting: project management, document generation, negotiation, collaboration and post-contract implementation tasks. Then, it automates pieces in the appropriate order to create greater efficiency, productivity, and accuracy.  

 

For example, with our solution, you start by creating a “project container” to recruit new providers. The system automatically generates individual opportunities for each provider within that recruitment effort, allowing you to streamline communication within your team.  

 

Once you reach the negotiation phase, the solution automatically creates standard contract documents based on provider types and specialties. These documents are shared with the relevant providers through an integrated system, with a link to the cloud storage site for collaborative review and negotiation.  

 

After an agreement is reached, the solution integrates with your electronic signature platform for electronic execution. The signed documents are then “ingested” back into the system, triggering an implementation checklist.  

 

Throughout the entire life cycle, the end-to-end solution provides real-time visibility into the status of each project-associated opportunity while enhancing accountability and reducing risk of missing an issue.  

Understanding the benefits of an automated end-to-end payer contracting solution  

As a healthcare payer, you likely have many goals, and one of the most common is expansion. However, with expansion also comes growing pains, many of which are tied to the contracting process. An end-to-end automated contracting solution helps manage these challenges by providing:  

  • Increased visibility and accountability. With real-time visibility into the status of ongoing contracting efforts, you can keep accountability on track. For example, during negotiation, an automated system might alert you to a specific action needed to reduce risk.  
  • Greater productivity. You might face tight deadlines for contracting a network of providers, and an end-to-end solution helps expedite processes. For example, you can automate standard contracting document generation based on provider types and specialties, helping reduce wasted time and meet deadlines more efficiently.    
  • Better mitigation of potential compliance problems and other risks. Tasks can be pre-configured based on regulatory requirements, helping track and highlight any changes during negotiations and minimize threats of contractual discrepancies and compliance issues.  

A more efficient solution can also help spot opportunities more quickly. By associating providers with multiple projects, you can more easily see who may have been recruited for various reasons and priorities. As a result, you can seamlessly transfer tasks from the project level to the opportunity and contract level while maintaining consistency and efficiency throughout the entire contracting life cycle.  

Payer contracting: Moving forward successfully in a digital era  

As healthcare payers manage increased regulations, evolving payment models, and other industry challenges, one thing is for sure: workflows are likely to get more, rather than less, complicated.  

As you work to keep up, tools that help manage the entire provider contracting process and life cycle help produce the efficiency and accuracy required to stay competitive and compliant.  

 

Are you curious about how to improve provider contracting in the digital age? Let’s talk and we’ll walk you through a complete overview of an end-to-end automated system.  

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