Creating and defining your provider network is a critical first step in managing patients and navigating them within your healthcare system. Whether you are building a new clinically integrated network (CIN) for payer contracting, standing up a new accountable care organization (ACO), or want to manage referrals from primary care to specialty care and services within your healthcare system.
The successful result of this is two-fold:
- Create a continuity of care for your patients to increase efficiency and effectively track quality.
- Increase opportunities to retain downstream revenue within your network.
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
- Up-to-date notifications on provider availability
In my role as the Director of a Patient Access Center for a large Colorado healthcare system, I faced a challenge common to many healthcare organizations: Create a provider directory that served the goal of a centralized, system-wide referral navigation program. We needed a robust provider directory for three key service lines:
- Community-Based Find a Provider Program
- PCP Referral Navigation
- Risk Patient Referral Navigation
The previous process was based on manual entry of providers, clinics and facilities in multiple systems and files, and Google Searches. The healthcare system used a credentialing software but maintained over 15 different, and often conflicting databases. In order to navigate patients to the most appropriate provider based on system alignment, geography, and specialty, we needed to create a master provider database. Despite concerns from individual hospitals, we were able to create a single provider directory in Salesforce that allowed us to both navigate patients to “in-network” providers but also track “out of network” provider usage.
We learned it was also important to track provider participation in the individual ACO’s, risk-based programs, and value-based programs. Some providers in the network may be employed, while others may be members of your CIN/ACO or be on active staff within a healthcare facility.
We found that 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.
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.
Provider Network Management
Silverline has created a Provider Network Management solution that includes:
- All services provided in the clinic by each provider
- All procedures performed in the clinic and the outpatient setting
- Up to date clinic and facility locations with directions, parking instruction, and public transportation routes
- Scheduling rules or restrictions at the provider, clinic or insurance level
- Provider availability by clinic or facility
- Providers and clinic management based on relationship tiers, (between the provider and the healthcare system)
- Provider Search accelerator for appointment scheduling, referral management, and other patient engagement center use cases
- Credentialing status and milestone tracking
Defining and building provider and facility profiles allow for the seamless navigation of patients throughout the system, ensuring that patients are referred within the network, and all unique attributes of their journey (barriers to care, support system, care team, etc.) are shared with the team.
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. Silverline can help you move away from spreadsheets, SharePoint, and notebooks for provider network management.
In summary, Silverline’s Patient Engagement Center solution also includes the tools to manage your provider network, as well as, manage provider referrals, perform nurse triage, manage care gaps, manage a risk-based population and much more. Wherever you start, Silverline has the tools and the experience to help you be successful.
To learn more about Silverline’s Healthcare Expertise, contact us today.
