If you have ever made a decision for your company’s healthcare partner, there is a good chance you didn’t consider this.
Did you know?
Healthcare plans from HMOs are only as good as the provider networks behind them. This article will show you why.
As an HR professional, you might feel you have done a phenomenal job. You chose the best Health Management Organization (HMO) for your company. You sign a one-year deal and give your team access to care. Two months later, you have a problem. Staff members walk into your office with various complaints. The provider facilities on your HMO provider network offer poor-quality service. You have even had to intervene in an employee’s healthcare emergency to change facilities during care.
You take it up with your healthcare provider and they promise to fix the problem. A few weeks later, they don’t, and you are getting more complaints. Your CEO is wondering why you have done such a lousy job in choosing a health partner. This is affecting your appraisal. You know you did the best you could but now that the result lacking, what did you miss?
Where you typically focus on when deciding on a healthcare plan for your organization
Business leaders and HR professionals focus on two things during HMO research. The benefits offered and potential business costs. Some take it a step further and try to ensure that they have a provider facility in the areas where their employees are located. Those are two excellent steps, but they forgo the last one which is ensuring the quality of the facilities on the provider network. They might also forget to investigate how HMOs maintain the quality of care on the network.
Provider networks are the list of individual healthcare centres curated by an HMO. They provide access to healthcare services for enrollees connected to a health plan. Healthcare organisations often create these networks to manage and coordinate patient care. Why are provider networks important?
Read More:5 Perks of your Reliance HMO Plan
How provider networks make all the difference to your healthcare plan
Adequate financial coverage to provide easy access to healthcare
Healthcare can be expensive for the end-user and the provider. Healthcare centres on provider networks have access to a higher financial limit. With this, they can provide appropriate patient care.
Wider Range of Services
Being on a provider network expands the reach of a healthcare facility and gives allows them to offer a wider range of services.
Provider networks create more income for individual healthcare facilities. This can help them improve their standard of care to patients.
Provider networks can be a valuable marketing tool for healthcare providers. That’s because of the providers’ exposure and the promotion of their services to new patients.
HMOs know you shouldn’t have to worry about the quality of care on Provider Networks
HMOs can run their own clinics, as it gives them total control of the quality of care and cost of care. However, this is not so scalable. The other option is the most common one. Most HMOs prefer to partner with different healthcare facilities to scale healthcare quickly.
However, limitations around quality and standardization of service exist when working with third parties. Some third-party centres might lack the ability to provide the standard level of service required. An HMO might choose a healthcare provider that lacks the ability to provide a particular standard of care. As a result, it cannot fulfil the promise they have made to its partners (like your organization).
Some HMOs like Reliance HMO anticipate this challenge and take a different approach. They own their clinics while also working with third-party providers. They can their own facilities to set a baseline standard of care for other providers on the network. More so, they can gain more insights about the specific needs that need to be met for the enrollees from your organization.
As the person in charge of finding a healthcare partner for your organization, your role is crucial. Go beyond asking for the benefits that suit your organisation. Ask questions about quality assurance across the provider network. You want to be sure that your healthcare partner can understand and fix any gap in quality of care as soon as possible.
When you do your research, you should include these three questions and keep your HMO accountable:
How do you choose the healthcare partners on your provider network?
How do you manage the quality of care on your provider network?
How do you support your providers to uphold the quality of care you have promised?
Here is how Reliance Health approaches these issues.
How we make sure the facilities on our provider network meet the quality of care we have promised
These are the factors we consider when we curate our provider network at Reliance Health:
Hospital Infrastructure and Safety:
We inspect provider infrastructure to ensure it is standard and safe. We sign-up providers who use the latest infrastructures and technology to deliver healthcare.
Quality of Care:
We ensure that providers on our network abide by best-practice guidelines. These include how they provide care and control infection. In turn, it will promote health and reduce mortality.
Customer experience determines how we rate a provider. These ratings determine the providers we sign. We collect customer feedback. Based on this feedback, we work with providers to improve their quality of care.
Timeliness and effectiveness of care:
For care to be successful, it must be provided in time and give the desired result.
At Reliance Health, we are very intentional with how we curate our provider networks. We pride ourselves in providing easy, affordable and accessible healthcare options. This will be impossible without the right kind of providers on our network.
How Reliance Health Supports Healthcare Centres on Its Provider Network
We maintain a cordial relationship with our providers. We provide the support they need to provide accessible and affordable healthcare. We do that in the following ways:
Our contact centres are accessible 24/7 to support our providers and enrollees.
Quick Authorization Approvals:
All our providers enjoy fast approvals with authorisations for consultations, investigations, and procedures.
We provide tech support for our providers with a provider dashboard. With the dashboard, they can manage all their requests and needs. We also provide training for our provider network. We train them to be faster, more efficient, and more effective in healthcare delivery.
Claims Pay-outs are faster:
All our providers enjoy faster pay-out of their claims once they submit their claims.
Our providers enjoy all RH offers to ensure all parties have a delightful experience.
We ensure that all providers in our network share our values and drive. If you are already working with Reliance HMO as your healthcare partner, you can make requests for new providers to be brought onto the network. We will take every step to make sure they are accountable and meet the standard of care we have promised you. The goal is to make healthcare services accessible, affordable, and delightful.
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