Improving Provider Relationships Using a CRM

Your CRM system is a tried and trusted sales tool, but if all it does is help you sell, you're missing out on incredible value. By leveraging your CRM to track and manage relationships with providers, you can get more from your investment while improving your service in the process.

Risky Relationships

Health plans deal with a tremendous amount of information. They are responsible for the upkeep and management of a variety of relationships, all of which are in a constant state of evolution. Payers must keep track of that information and leverage it properly to provide the highest level of service to all their constituents: members, providers, and brokers.

If it were only provider practice locations and billing information, Excel or a simple database might be an appropriate tool. But today there's so much complex information to coordinate and communicate. Payers must ensure their providers are licensed and certified appropriately; ensure their provider directories are up-to-date; confirm providers follow government-specific standards of care; and ensure continual compliance. Under the latest regulations, failure to comply with keeping their providers and their data current can have significant monetary penalties for the carriers.

Relationship management in this new environment is complicated and ongoing. Building out a CRM platform's capabilities to meet the needs of health plan organizations can be transformative to your provider relationships.

Why CRM?

Rather than getting by with suboptimal tools, you can build capabilities and add applications to your CRM to track and operationalize your teams' coordination and communication.

The right CRM modifications let you track communications, training plans, remediation plans, and other critical parts of the health plan-provider relationship. Workflow engines within the CRM make it easier for you to implement proper follow-up timing and manage SLAs; for example, managing cases involving doctor complaints in the appeals and grievances process. These engines can also use cyclical update processes to throw alerts when provider licenses, contracts, and certifications come up for renewal. Rather than rely on manual workflows, the CRM interprets all the necessary information to make relationship managers and service teams more effective.

With the right additions, a CRM can even help you track and manage audit results. After all, you are the one responsible for ensuring provider audits follow a standard procedure, stick to a schedule, and conclude with proper documentation. Fulfilling these responsibilities is critical to preparing for inevitable CMS audits.

Building a Smarter CRM

If you're ready to build a CRM that can unify companywide data and processes, remember that developing the tools for your unique needs takes time and expertise.

To get started, consider the following pieces of advice:

1. Use data to track relationships.

Put provider data into a system that can truly track the details of the relationship. Don't settle for static demographic records. Track visits, communications, course completions, and integrate third-party benchmark data to create a complete and accurate picture of your providers. Remember that CRM data must be live and updated to be useful to frontline teams or to drive useful analytical results.

2. Standardize the system for companywide use.

Implement standard processes that work for everyone in the company. CRM integrations are not easy feats, and usable processes with scalable characteristics are easier to imagine than to implement. Avoid pitfalls by working with an expert provider, planning for multiple workflows, integrations, and user types, and be sure to fully test before launching.

3. Make it provider-friendly.

To truly create the data pools that you need for strong analytics, build a system that integrates well with your existing network management, provider contracting, and claims systems. Better yet, put providers and their data into a relationship management tool to improve those communications at the same time. Not only can you improve experiences for your providers, but you can also create a platform that ensures your data is up-to-date and in-compliance.

There's an avalanche of data coming your way every day, and new, complex responsibilities piling on health plans and their providers. Without the right tools for the job, your organization will be hard pressed to keep up and respond quickly and correctly. Tracking, managing, communicating, and coordinating with providers is difficult, but a smarter CRM can handle all that and more. To stay in compliance and gain a competitive edge in an evolving healthcare market, don't sleep on the power of an improved CRM.

When you're ready to make the leap, don't go it alone. Let us provide you with the tools and guidance for a successful implementation and beyond. To learn more, read about our Provider Forward app.