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Your Provider Roadmap to Success: How to Manage Provider Relationships

Healthcare

Silverline is focused on helping healthcare organizations, as providers of healthcare services to patients, be successful in five key areas as healthcare reimbursement models shift from fee for service to fee for value. This article will focus on how to leverage the Salesforce platform and effectively navigate patients on their healthcare journey. The information provided is based on my twenty years’ experience in healthcare and twelve years creating and operationalizing patient journeys utilizing Salesforce for large healthcare systems in Texas and Colorado at the physician group, clinically integrated network (CIN) and healthcare system levels.

Here are five areas we are exploring:

  1. Provider Relationship Management
  2. Consumer & Patient Engagement
  3. Ambulatory Care Coordination
  4. Transitions in Care
  5. Specialty Care Coordination

We will view these opportunities in the context of using Salesforce and leveraging Silverline’s suite of solutions and accelerators.

Provider Relationship Management

Creating and defining your provider network is a critical first step in managing patients and navigating them within your healthcare system. The successful result of this is two-fold: create continuity of care for your patients to increase efficiency and effectively track quality, and increase opportunities to retain downstream revenue within your network. Whether you are creating a new clinically integrated network for payer contracting, standing up a new accountable care organization (ACO) or simply want to manage referrals from primary care to specialty care and services within your healthcare system.

The key to defining your provider network in a manner that impacts your patient navigation is to build and maintain provider profiles that go beyond the traditional credentialing data to include services provided in the clinic; procedures performed in the clinic and the outpatient setting; locations with directions, parking instruction, and public transportation routes; scheduling rules or restrictions at the provider, clinic or insurance level; and up-to-date notifications on provider availability.

It is also important to track provider participation in your individual ACO’s, risk-based programs, and value-based programs. Silverline’s Provider Network solution includes the ability to manage contract requirements, compliance, and milestones. It also allows you to create and manage the providers and clinics in tiers, or the relationship between the provider and the healthcare system. For example, some providers in your network may be employed, while others may be members of your CIN/ACO or be on active staff with a healthcare facility. Silverline’s Referral Management accelerator includes safe harbor scripts to inform the consumer/patient of the relationship between the provider and the healthcare system and the order in which providers will be offered.

One unique approach to provider network management is to manage the onboarding process for providers and clinics in Salesforce. This has been done very successfully at a large provider group in Texas. Tracking the HR, IT, Telecom, Real Estate, Legal, Credentialing, and other processes in Salesforce allows the individual departments to collaborate and simplify communication while introducing the provider to the new network and the network to the new provider. This can help change referral patterns and increase in-network utilization up to 90 days before their go-live date.

Finally, engaging with providers in your network is critical to increasing quality and enhancing the patient experience. Provider Relationship Managers, sometimes called Physician Liaisons, are valuable members of the provider network but often lack the tools to effectively communicate and track their relationship with providers or collaborate with others calling on providers or clinics. Whether it’s gathering the latest provider and clinic demographics, automating communications and updates within the network or sharing information with providers on the status of referrals, Silverline can help ease the burden. Move away from spreadsheets, SharePoint, and notebooks and consider using Salesforce Communities as the hub of information sharing within your provider network.

Stay tuned for the next article in this series that will focus on: Consumer & Patient Engagement. Want to learn more about Silverline’s Healthcare Expertise? Contact us today or comment below to add to the conversation.

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3 Comments on "Your Provider Roadmap to Success: How to Manage Provider Relationships"

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Kaia Brown
Guest

Our organization is exploring the possibility of moving data from our medical credentialing and enrolment database into Salesforce. Is there someone I could connect with to discuss this?

Craig McKeon
Member

Hi Kaia, we would be happy to discuss a solution for your organization. Natasa Marinkovic from the Silverline team will be reaching out to you shortly. Thank you!

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