Healthcare Provider Network Management

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Healthcare Provider Network Management

The rise of telemedicine and retail clinics, narrow networks, and efforts to augment care quality and cut costs are examples of insight showing that companies are moving toward utilizing third party vendors for their healthcare provider network management. On the other hand, Henry Ford Health System is an example of a healthcare business that expanded its existing 'open scheduling' feature to accommodate more groups.

i. Insights into Companies Using Third-party Vendors for their Healthcare Provider Network Management

Efforts to Cut Costs

  • Many companies are moving towards using third-party vendors for their healthcare provider network management to cut costs. Research findings show that six percent of companies providing benefits eliminated a hospital or health system from their network provider to reduce their plans' costs.
  • Most companies are moving towards tiered networks, which categorize the providers in the network based on cost savings and quality of service provided. About 73% of all firms move to tiered networks to attain both quality and cost-efficiency.
  • Likewise, approximately 13% of firms prefer tiered networks due to cost and efficiencies. Another nine percent use tiered networks for quality purposes, while only 4% of firms use tiered networks based on neither cost, quality, or efficiency reasons.

Narrow Networks

  • Statistics show that 55% of companies offering health benefits cite that their biggest enrollment plan uses a ‘very broad’ network, while 37% claim that theirs is ‘somewhat broad,’ and 7% note it is ‘somewhat narrow
  • When considering cost savings via narrow networks, 39% of employers claim that they cannot reduce network size to realize cost savings. Another 11% claim they can shift to narrow networks if they realize cost savings from 20% to 30%.
  • Research findings indicate that only 8% of employers are directly contracting with health care providers; therefore, an estimated 92% who are not directly contracting are likely using provider networks.
  • The employers who are directly contracting seek specific services, including "bariatric surgery, infertility, cardiac surgery, orthopedic surgery, oncology, maternity, and transplants."

The Rise of Telemedicine and Retail Clinics

  • Alternative care settings such as telemedicine and retail clinics are fueling the adoption of third-party vendors in the healthcare environment to facilitate the management of healthcare provider networks.
  • Since 2015, the percentage of large firms claiming to offer telemedicine has climbed from 27% to 39% in 2016 and 63% in 2017. Equally, in 2017, an estimated 75% of firms offering health benefits cover care offered at retail clinics, such as those located in malls, retail stores, chain stores, supermarkets, etc.
  • The rapid rise is an indicator that many firms are using third-party vendors to deliver telemedicine services, which include messaging, video chat, remote monitoring, etc. Therefore, it is likely that large firms are using third-party vendors to offer some of these services.

Third-party Breaches

Reliance on Many Customer-facing Software Systems

  • Healthcare businesses rely on numerous customer-facing systems that pose challenges when integrating new technology changes to these systems.
  • About 53% of healthcare organizations take months to a year to implement new technological changes because an estimated 62% of them use from two to ten customer-facing software systems.
  • Likewise, about one-third of healthcare organizations are not aware of the number of software systems they are using.
  • In this regard, 58% of employers are planning to consolidate their technology platforms for simplicity, 49% are seeking to enhance agility, while 43% aim to migrate to cloud-based applications.

Varying Market Size Figure

  • While the two market sizes provided in early research feature contradicting figures, in-depth analyses on the same have uncovered that the report citing the market at $3.12 billion provides a breakdown of the market based on components, platforms/services, and region.
  • On the other hand, the report citing the market at $47.6 billion does not include any breakdown on the market, whether by parts, region, etc.
  • Interestingly, a report by MarketsandMarkets quoted the market at 2.96 billion by 2020. In this regard, it is assumed that since two reports provide more related figures that focus on the component and platforms/services segment of the market, then their values appear more accurate versus the one claiming the market is about at $47.6 billion.

II. Key Players in the Healthcare Provider Network Management Market

TriZetto Healthcare Administration Solutions

Ayasdi: Artificial Intelligence for the Enterprise

McKesson Corporation: RelayHealth Pharmacy Solutions

Genpact Limited

  • Genpact Limited provides a robust enterprise performance management (EPM) system designed to help companies "redesign corporate performance, improve insights, and enable action."
  • The company's EPM includes an AI-based platform — Genpact Cora, which automates business operations, boosts agility, and provides timely insights and reports regarding the performance of the business.
  • Genpact Limited EPM's competitive advantage stems from its consulting-led approach that utilizes governance and performance frameworks. The approach turns EPM into an important business driver.
  • The EPM solution boasts over 100 blue-chip clients, more than 4,000 EPM domain experts, and a geographic footprint spanning over 70 countries.
  • The solution claims to help "optimize enterprise performance management, improve planning, budgeting, and forecasting, streamline performance reporting, and create an effective EPM organizational model."
  • Genpact Limited targets various industries, including healthcare, life sciences, insurance, etc.

Atos/Syntel

III. Case Studies: 'Find a Doctor' Feature

Henry Ford's Open Scheduling with Epic EHR Software

Ear, Nose & Throat Surgeons of Western New England

Research Methodology

To uncover insights that indicate whether companies are moving toward utilizing third party vendors for their healthcare provider network management, your research team began by exploring industry report focusing on provider network management solutions. We focused on reports, articles, surveys, and studies published by network management solutions' vendors, along with healthcare organizations, including Health Systems Tracker, KFF, Managed Healthcare Executive, Health IT Security, Catalyze, among others. These vendors contained both qualitative and quantitative data with insights suggesting that some actions taken by companies indicate an affinity for relying on services of provider network management.

Next, to identify five to six key players in this space, we relied on industry reports discussing the market size of healthcare provider network management. We focused on those players that are headquartered in the U.S. and offer services nationally. Based on initial research, some key players identified include TriZetto, Ayasdi, McKesson Corporation, Genpact Limited, and Atos/Syntel. Other examples, such as Infosys BPO and Mphasis Limited, are India-based. These companies are ranked key players based on the market share they hold in the provider network management market.

Lastly, the case studies provided were published by the respective third-party vendors of open scheduling solutions and feature examples of companies transforming from a company created "find a doctor" feature to one provided by third-party vendors. The case studies focus on Ear, Nose & Throat Surgeons of Western New England, and the Henry Ford Health System.
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