Payor Contracting

Why Experience is Key To Successful Network Expansion

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Expanding your health plan is a complicated process with many pitfalls and CMS’ ever-shifting standards. Without mentioning the difficulty of meeting deadlines and therefore being able to take full advantage of a new service area expansion (SAE) quickly, expanding your plan’s reach into new counties requires near constant attention on the regulatory and management hurdles. Without a well-managed team that brings years of experience, you run the risk of missing opportunities and stalling product development for the plan.

That’s where PayrHealth’s team comes in. Our dedicated network development staff have years of experience on the ground and within health plans creating strategies based on the shifting best practices of each new year.

Timelines Change

Network development teams like PayrHealth are constantly watching the changes from the Centers for Medicare and Medicaid Services regulations and standards because they can affect internal team budgets and timelines by months or years down the road. When their rules change, we notice and make a plan to shift priorities.

For example, when CMS announced the shift in application deadlines to be due prior to submission of finalized Health Service Delivery (HSD) tables, it not only provided extra time to solidify contracts, but also placed a greater burden on internal teams to make the best use of that time. No longer did product development have the luxury of a final plan as early as Q2, so the process between network expansion and product strategy became more intertwined.

This level of experience and awareness of how to utilize changes in annual deadlines is hard to come by unless you’re working with a team of experts who spend their full time analyzing data and working with practices in all 50 states to know where your best opportunities lie when timelines – internal or external – shift.

Adequacy Standards Change

As plans file their Notice of Intent to Apply each year, you’re not only pitching to CMS, but also to your own plan. Knowing which counties are on the cusp of adequacy is key to pitching your strategy to decision makers in the C-suite. Adequacy standards are as fluid as anything when it comes to SAE, meaning prospects that didn’t exist last year are now much more attractive targets that your plan can benefit from.

Just like with changing timelines, fluctuating adequacy standards can provide headaches for teams that don’t have the breadth of experience needed to adapt to changing priorities.

Benefits of Experienced Outsourced Network Management

With a team like PayrHealth helping your health plan scale, you don’t just get additional capacity, but experts who have real-time data and current relationships with providers across the country. We help health plans bridge the gap and make smart decisions about where they’re most likely to get high-impact results from their SAE, no matter how regulations shift. Additional benefits of hiring experienced network development professionals include:

  • Access to strong relationships with providers nationwide
  • Custom strategizing for your goals and risk tolerance
  • Automated tools to simplify HSD table preparation and CMS filings

Take advantage of our team’s decades-worth of experience with network development and see how you can benefit from partnering with PayrHealth, the leading bridge between providers and payors. Call or contact our team online today to learn more.

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