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Top 4 things medical professionals want from health plans

The biggest problem that physicians have with health plans is a lack of standardization. This leads to frustration among both doctors and administrative staff. The lack of transparency, the complexity, and the inconsistency of health plans is enough to confuse and frustrate almost anyone.

So to help health insurance companies better understand the needs of physicians, we’ve put together a list of the top 4 things that all medical professionals want from their healthcare plan. Following these quick tips will lead to an increase in provider satisfaction and streamlining of processes, allowing physicians to perform their duties without getting bogged down in day-to-day administrative tasks.

1. A more efficient, streamlined physician credentialing process

Physician credentialing by health plans can be a huge burden. New physicians cannot be certified to provide services to health plan providers for nearly half a year – leading to poorer patient outcomes and lower healthcare provider satisfaction rates with your plan.

The main issue here is that each health plan often uses a separate credentialing process. Although there have been attempts by organizations such as CAQH to standardize this process, most health plans still use their proprietary processes, leading to inefficiencies and longer wait times.

A streamlined, efficient process that is universally adopted by health plan providers could drastically cut down on these inefficiencies.

2. More Effective Pharmacy Communication

Communicating with pharmacies about prescriptions, refills, and specific formularies can be very time consuming for physicians. Prescriptions and refills are easier to deal with, but the increasing complexity of formularies across different health plans leads to some major headaches for physicians.

The biggest problem is that a doctor may not have easy access to a particular healthcare formulary when seeing a patient. If the patient is recommended a drug that is not on the formulary of their healthcare plan, they will have to deal with the pharmacy to recommend a drug that is covered by the health plan.

This could be addressed if health plans made their formularies easier to access. Building a comprehensive formulary list into a medical plan provider portal would be a good start, as physicians would have easy access to all the information they need to make the right prescription recommendations to their patients.

3. Standardized health plan contracts

Constant health plan contract renegotiations are a huge drain on the resources of healthcare providers. Most healthcare provider contracts last only 1-3 years and negotiations begin approximately nine months before the contract ends, leading to a lot of wasted time that physicians have to spend negotiating with health plan providers.

On top of this, because renegotiations and contract renewals occur frequently, the average practice deals with approximately 20 healthcare plans.

And, though these renegotiations are necessary due to changing costs, economic changes, legal changes, and other factors, physicians must spend a lot of extra time reviewing the legalities.
If health plan providers simplified and standardized their contracts, more time could be dedicated to negotiation and less to the review of wasteful paperwork.

4. Increased utilization of electronic payments

Paper checks are a plague on the medical industry. The $2.9 trillion medical industry still runs on paper checks—not just from patients to healthcare providers, but also for payments from plan providers.

Paradoxically, the number of payments issued by check since 2000 has increased, despite the availability of streamlined, efficient eCheck technology such as Deluxe eCheck Payment Solutions. Only 15 percent of all commercial insurers are making payments to medical providers using electronic methods despite the fact that most healthcare providers prefer electronic payments.

Using smart eCheck and electronic payment technology could increase efficiency by eliminating unnecessary paperwork and administrative tasks, and allow physicians to deliver better care, and spend less time managing payments and billing.

Easy steps to raise healthcare provider and physician satisfaction

Healthcare providers would be wise to pay attention to these physicians preferences:

  • Streamlining credentialing.
  • Allow clear lines of communication with physicians about formularies.
  • Standardizing healthcare contracts.
  • Switching to electronic payment methods could lead to massive increases in physician satisfaction.

Also, the increased efficiency provided by these standards could result in large cost savings for both healthcare providers and health plan companies, and help provide members and patients with better quality of care.

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