We Help make YOUR INSURANCE NETWORK
Provider Network Development
Essential HealthCare Solutions’ network development professionals provide quality support for developing local, regional, and multi-state network provider networks including specialty networks including vision, dental, LTSS and behavioral health. We have experienced provider and hospital network contracting experts. Our proven network expansion strategies, market knowledge, and innovation approach allows the necessary foundation for our clients to manage cost while developing high performing networks on time and on budget without the burden of hiring and training additional staff or increasing salary wages and benefits. We design a market expansion strategy to meet client’s needs within their competitive landscape. EHS leverages our relationships with both the provider and payor community to create insight and effectively communicate to properly deliver the value proposition. Our consultants provide competitive contract negotiations within preset guardrails to deliver positive results and market penetration. Whether you’re an organization that needs to evaluate the provider dynamics in a specific market to support expansion or you’re a health system or provider group seeking to position itself to contract with payers, EHS’s network team can provide you with a thorough assessment of strategies to succeed in a specific market.
Network Development Lines of Business
- Commercial Insurance & ACA Exchange
- Medicare Advantage (MA)
- Workmen’s Compensation
- Long Term Services & Supports (LTSS)
- Home and Community Based Services (HCBS)
- DSNP (Medicare / Medicaid dual eligible)
- Self-Insured Employer Groups
- Government Support Contracts
Who We Support
- Start-Up Health Plans
- Commercial HMOs
- Commercial PPOs
- Managed Medicaid Plans
- ACA Exchange Plans
- Medicare Advantage Plans
- Clinically Integrated Network
OUR APPROACH TO
A comprehensive solution with the following three key areas:
Provider Speed to Market
We have developed provider networks at a national & state level and can meet very aggressive milestones, engage providers and deliver value for national, regional and local clients. Our team supports federal and state government as well as self-insured employers
High Performing Networks
Network status visibility and prioritization with competitive negotiations, well priced networks and ability to monitor goals. Our total provider network solutions improve outcomes, ensure compliance and control costs with a focus on value-based reimbursement models, direct contracting entities (DCE), and clinically integrated networks
Engagement of providers and facilities in the market area quickly to establish value proposition and relationships for network growth and sustainability as well as network gap strategy and contracting to ensure network adequacy.
- Analyze industry trends
- Provider Network Market Analysis – We provide comprehensive market analysis to our clients to enhance network development strategy. Our analysis includes utilizing our internal provider and hospital database to provide our clients with healthcare commercial intelligence that untangles the web of data to identify high preforming providers, healthcare systems, and other healthcare organizations for any type of provider network
- Support the negotiation of complex, value-based payor agreements
- Manage provider risk pool settlements
- Develop Optimal Network Performance
- Manage risk adjustment methodologies and financial impact for commercial and Medicare Advantage population
- Transition to from FFS to Value Based Contracts
- Vast understanding of medical cost trends that drive gains and losses across risk pool
- In-depth knowledge in value-based contract methodologies
- In-depth knowledge in at-risk contract methodologies
- Improve terms for quality measures
- Data Support to provided additional resources for reporting and network analysis
- Provider Network Operations Support – Provider training, contracting data integrity and workflow
- Provider Credentialing Support
- Provider Directory Accuracy and Provider Data Validation
The EHS Network Development Team
Type of Consultants
- Value-Based Contracting Consultants
- Hospital Contracting Consultants
- Physician and Ancillary Contracting Consultants
- Data Analysts
- Extensive hiring screening and background checks to ensure a thorough evaluation before project assignment for each EHS consultant to properly align each consultant’s experience with the needs of the client.
- We utilize internal resources to scale quickly and effectively to meet the needs of clients to ensure we meet project goals.
- EHS has over 100 consultants ready for project engagement to support a 7-day ramp-up after executed scope of work.
- EHS consultants are geographically diversified to offer boot-on-ground network development resources.
- Multi-Tiered Staffing Model - We have three (3) professional tiers based on experience and contracting skill set to maximize financial resources and control project costs.
- Network development team is structured with a multi-tiered project management oversight design and with project leads to monitor performance and progress.