Making Provider Engagement a Priority

If you’re not making the same kind of effort to engage with your providers as you do with your members, then you’re missing out on an opportunity that can affect your bottom line.

Engaging providers with your platform can help reduce administrative costs and help you meet or exceed quality measures…like your Star rating and HEDIS score. And according to Navigant, improving from a 3-star rating to a 4-star rating could increase revenue between 13.4% and 17.6%.

That is, of course, if you equip them with data and intuitive tools that help them deliver timely and appropriate patient care. Because provider engagement is about empowering your providers to work more efficiently so you can both abandon expensive and inefficient, manual processes.

And when you prioritize engaging your providers, together you can better serve your members, leading to improved quality ratings and scores.

Here’s what happens when your platform is optimized for your providers:

Close Gaps in Care

Gaps in care occur when members don’t receive the health services that their demographic and other factors require. And the more pervasive these gaps are throughout a member population, the more likely that quality of care will suffer, along with your Star rating and HEDIS score.

So, it’s important to recognize that you and your providers are partners in care. Even though they deliver care, you often have more comprehensive data about the patient care requirements necessary to identify the care and services your members need: claims data, demographic data, clinical data, medical records, and compliance standards. Sharing that data with your providers (ie partners) equips them to take the necessary actions to close gaps in care.

Unfortunately, most payers don’t have efficient ways to share this information. They fax or email reports listing gaps in care, requiring providers to look up each individual patient in the most recent spreadsheet. As a result, many of the best opportunities for providers to close gaps are lost, like when the patient is in their office or on the phone.

The Healthx Quality Measures tool gives providers access to all of your relevant data and displays it in intuitive ways, making it easy for them to take action. Providers can be notified of members with gaps in care through the Quality Measures tab on your platform. From there, all gaps in care can be viewed at once or displayed by specific gaps—eliminating the need to look up each patient individually. Or, when providers pull up individual patient profiles on your platform to verify eligibility and benefits, they’ll see notifications about gaps in care so they can handle them on the spot.

Reduce Admin Costs

Prior authorizations are among the most tedious—and expensive—healthcare transactions. They require providers to supply extensive documentation and back and forth communication to explain why services are necessary. According to the 2018 CAQH Index, these transactions typically cost payers $3.50 each when completed manually. But when providers submit authorizations digitally using an engagement platform, that cost goes down to 3 cents.

Administrative savings like this are only possible when providers are engaged and understand how to use your platform. And you’re not just reducing your administrative costs, but also those of your providers. This also decreases the time spent on these administrative tasks, which gives providers more time to spend with their patients (your members).

Imagine the efficiencies and savings of performing basic transactions online instead of fax, email, postal mail, or by calling your support team. Imagine the impact of streamlining the authorization process to not only improve efficiencies but also provide opportunities to expedite the delivery of care.

A True Partnership Based on Quality

Working with providers is one of the most effective ways to close gaps in care, improve efficiencies, and advance the delivery of care. Healthx creates opportunities for you and your providers to realize these benefits and achieve higher levels of service.  


To learn more about how you can set providers up for success, improve quality ratings, and improve your bottom line, talk with one of our experts today.