For provider networks, the process of engaging, vetting, contracting, and connecting to Payers has always been long and laborious, creating a drag on valuable time and resources.
Much of the friction in the process can be attributed to cumbersome system integrations. Information is disparate and decentralized, and the process can take several months, costing networks both time and money. Slow onboarding and maintenance with each individual Payer can further bottleneck progress, especially when Payers use homegrown or complex data management solutions.
The result: prolonged timelines and missed opportunities, along with inefficient communications and a lack of automation that can plague both parties – not to mention information that can be accidentally duplicated or missed entirely.
Additionally, the demand for resources can ebb and flow, typically peaking in the 4th quarter, with networks facing constraints that result in pushing back implementations and potential loss of a Payer due to delayed launch. Time is always of the essence, as any changes or customizations to a network’s systems to accommodate Payer file formats, data transformations or protocols must be incorporated within a reasonable timeframe.
Given the significant effort and personnel expense that goes into connecting and operationalizing, networks must evaluate and prioritize bandwidth when deciding whether or not to work with a Payer. There may be times when an opportunity must be turned away, simply due a lack of available resources to go live on a Payer’s desired timeline. What’s more, networks must ensure that any Payer they expose to their contracted providers will not put these relationships in jeopardy.
Provider networks are all too familiar with these challenges, but they don’t need to accept the status quo any longer. There is a solution: an Intelligent Health Market.
What is an Intelligent Health Market?
An Intelligent Health Market brings the power of a marketplace to healthcare, using data to help provider networks earn new revenue, expand their market and grow their business, without requiring investments in additional resources.
A network connected to an Intelligent Health Market enjoys greater exposure to Payers because any network connected to the platform is ready to support Payers’ needs from the get-go, thanks to a standardized process from start to finish. This allows networks to:
- Go-live sooner
- Be at the right place at the right time for Payers
- Integrate more easily and with less cost over time
- Reduce resource demand per implementation
How MacroHealth Connects Networks with Payers
This is the MacroHealth Intelligent Exchange platform (see graphic). The platform provides a marketplace experience for Payers to to connect with provider networks, adhering to the standards, protocols, data formats and transformations required by both the Payer and the network. There are two main components which support and drive the marketplace experience: Optimize and Connect.
Optimize: Working with MacroHealth, Payers identify their optimal mix of network partners. At the same time, partner networks can market themselves to Payers at scale, increasing their exposure to organizations that fit their ideal customer profiles based on their own business rules and selling criteria.
Connect: Each and every Payer is unique, and each Payer implementation is unique as well, typically requiring significant resources at the network. With the Connect component of the MiX platform, networks can seamlessly connect to a Payer, or multiple Payers, without investing additional resources.
Additionally, all connectivity and end-to-end data testing is managed by MacroHealth. Once an initial integration is complete, similar work does not need to be repeated for any other Payers that connect to and integrate with the network through the MiX platform. Every new Payer that MacroHealth integrates will be done with the same level of security and reliability as the first integration with that network, but with the advantage of minimal additional effort.
Unlocking the Value of Data- Yours and Ours
Underneath Optimize and Connect, the platform relies on a Data Factory and technical infrastructure to enable and support the marketplace experience. The Data Factory is a substantial data lake, which includes Payer data, third-party data, and MacroHealth data. This helps to ensure that all Payer-network partnerships are an optimal fit.
MacroHealth brings insights to network partners in the form of in-depth Payer discovery, surfacing Payer needs, pain points, strategic headwinds, and much more. Payers rely on MacroHealth to help them fuel innovation and growth, enabling us to be aware of issues and trends as they develop. We share those insights with our network partners to help accelerate their growth in turn.
What can partnership do for you?
An Intelligent Health Market, like the ones created by the MacroHealth Intelligent Exchange platform, can unlock new opportunities for success by leveraging the power of data and a marketplace approach – enabling networks to transform the ways they access and connect to Payer ecosystems, while reducing the resource demand for every new implementation.
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