Successful Provider Onboarding in Stressful Times

As healthcare organizations scramble to meet the immediate demands of the coronavirus pandemic, rapid onboarding of new providers is a pressing need.

Successful Provider Onboarding in Stressful Times

As healthcare organizations scramble to meet the immediate demands of the coronavirus pandemic, rapid onboarding of new providers is a pressing need.

 

While the urgency of this moment is unique, the ongoing challenges and importance of efficient provider contracting, credentialing, privileging, and enrollment are not.

It is no surprise that in the current climate, speed tends to be the first consideration; overwhelmed hospitals and health systems are under enormous pressure to get qualified providers in front of patients as quickly as possible. Yet, even in less urgent times, speed matters. Faster provider onboarding impacts patient care, provider satisfaction, and the integrity of the health system’s revenue cycle. Every month that provider enrollment is delayed, physician practice groups and health systems lose an average of $100,000 in revenue for a single primary care provider and as much as $300,000 per physician for a specialty care provider. Furthermore, an efficient provider onboarding process establishes a trusted foundation for a strong and durable working relationship where physicians can feel confident that the health system is focused on relieving physicians’ administrative burdens. Compare that with an inefficient process that compromises care coverage and potentially undermines health system initiatives, creating instability in the workforce.

Need for Speed Cannot Compromise Need for Rigor

But as health system executives know all too well, onboarding providers is no simple matter. The process is triggered with a provider contract. Every provider agreement includes terms that detail highly regulated aspects of the relationship, including compensation, bonuses, and CME reimbursement. Thus, rapid onboarding must also ensure compliance with the many standards and regulations that govern provider contracting. To do so, health systems must:

  1. Consolidate their contracts in a central, readily accessible database. That’s the minimum for establishing across-the-board visibility necessary for streamlining costs and mitigating risks.
  2. Standardize contract language within the database to mitigate cost and compliance risks associated with nonstandard terms and conditions.
  3. Have a way to reliably analyze contract language to ensure they are getting the right price and contract terms, both in the original contract and at renewal. Mistakes can drive thousands — even millions — of dollars in unnecessary costs, including fines that can devastate operational budgets.

Despite understanding these challenges — or perhaps because they understand them all too well — many hospitals and health systems make enormous investments of human resources in provider contracting and onboarding. The problem with this approach is threefold: 1) human beings cannot work even close to the speed of today’s technology; 2) manual activities are typically siloed, taking place across several departments that far too often don’t communicate with one another; and 3) humans are all too vulnerable to, well, human error. Delays and mistakes are costly, in both dollars and human lives. Long-term, delays and mistakes pose unacceptable risks to any health system operation.

The Benefits of AI-Powered Technology

In contrast, a healthcare-specific contract lifecycle management solution — working in concert with cloud-based credentialing, privileging, and enrollment software and supplemented by expert services — provides both the necessary speed and rigor. The integration of these elements digitizes provider contracts and monitors critical dates, terms, and notifications. It automates downstream triggers such as initiating credentialing and privileging, ensuring timely enrollments, and governing provider communications. It can validate data at the source, enabling changes in provider credentialing to feed back into contract management workflows and reports, and allowing real-time review and corrections.

Such solutions can also incorporate analytic software to identify contract variability that exposes organizations to compliance risk. Using a form of artificial intelligence, the software can identify the key terms and clauses in provider contracts that enable healthcare organizations to effectively govern provider relationships, manage physician total compensation, correctly navigate mergers and acquisitions, and ensure compliance with regulatory standards.

In normal times, the key benefits of such technology and services include the rapid enhancement of revenue flow and the preservation of dollars associated with an efficient operational infrastructure, competitive contract pricing and terms, and mitigating the risk of regulatory fines. We’ve seen health systems garner a 400 percent return-on-investment by implementing cloud-based analytics and IT-enabled provider onboarding services, while also decreasing contracting and onboarding timeframes by 68 percent.

These are powerful benefits at any time, but especially in today’s crisis, when speed and attention to detail in provider contracting and onboarding are critical both to preserving revenues and, most importantly, to ensuring that patients receive the care they need and deserve.

Author:

Anna Arutyunyan

Vice President, CVO, Provider Management

Anna has extensive experience in the development and implementation of full-scope credentialing programs.

 

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