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Provider Network Management
McKesson's Provider Network Management solution enables health plans to reduce network administration costs. It automates the rapid design and rollout of networks, eliminating the burden of manually affiliating providers to networks. It transforms the networks into building blocks that can be aligned with market facing products to enable product value differentiation per customer segment.
Business Challenges:
- Complexity and effort in introducing new networks and products
- Supporting new network designs such as client specific networks, narrow networks, specialty networks, etc.
- Steering members from health insurance exchanges to optimal providers and care teams
- Increased demand for tailored/personalized networks by employer adoption of VBID and VBP
- Claims system’s inability to support new network designs and associated reimbursement policies
- Ability to scale new care delivery models such as ACOs and PCMH from pilot
Key Features:
- Network analysis
- Criteria-based network eligibility & scope design
- Products to networks mapping (network product offering)
- Networks to contracts mapping (contract provider grouping)
- Contracts to reimbursement mapping
- Network modeling
- Network guideline enforcement
- Network hierarchy
- Automated network deployment and maintenance (system-driven provider to network affiliations)
Key Benefits:
- Increased competitive differentiation through enablement of product and network innovation
- Increased health value and economic value through improved network performance
- Decreased administrative costs and cycle times for network management
- Enablement of provider rate differentiation to drive provider performance
- Increased member steerage through alignment of benefit and network designs
