Ep 14 - The Evolution of Payer Networks in a Changing Healthcare Industry

The healthcare network, made up of providers and managed by payers, is one of the most important aspects of the entire industry. It forms the foundation upon which patients base their expectations, the primary component which payers use to attract members, and that providers use to ensure visibility among patient populations looking for services. However, recent events have fundamentally altered the way all three use networks. To better understand the many changes that the healthcare network is experiencing and what these changes mean for building a robust payer network, Future Healthcare Today spoke with three network solutions experts from Zelis.

“Member needs are changing,” Robin Marino, Director for the Zelis Dental Network said. Marino mentioned that trends like “dispersed workforces, work from home, new technology, all these combined with an evolving set of expectations from patients mean that payer networks need to change to keep up and remain competitive.”

“[Building a competitive network] requires an understanding of patient needs, provider demographics, and geographic areas,” Tammie Skiles, Senior Vice President for Network Solutions, explained. “[Together these, among other variables] are how we define competitiveness of a network, and payer networks need to be competitive to be successful.”

Frequently, however, health plans lack the resources to best track changes that impact their networks’ competitiveness. “If a health plan does have a network, it often isn’t their primary focus,” Kim Sharbatz, Senior Director for Strategic Network Partnerships, said. “They are more focused on growing their product ...making it tough for network areas to battle for resources.” This can be a problem for payers when their network is not keeping pace with the evolution of the healthcare industry.

With payer networks at a crossroads and no sign of the pace of change slowing, Future Healthcare Today shares how to build a robust network and how to ensure its success for years to come.