The top considerations when empaneling a provider into our network include several key issues, which are:
- Quality of care
- Patient welfare
- Affordability of care
- Working relationships that are both collaborative and commercial
- Digital solutions.
Quality of care and patient welfare
First and foremost, we only want providers in our network that clearly demonstrate that quality of care, and the health outcomes of our members, are at the forefront of their mission. Clearly, many providers market themselves in such a way, but we are really interested in partnering with providers that live those values, and do so in a financially responsible environment where they are conscious of the entire value chain and respect all parties.
Providers must treat our members as patients in their care, not a means to a revenue cycle. Providers will be rewarded financially for their skills, expertise and patient outcomes, but this financial compensation should be the reward, not the objective.
Providers that are identified in the practice of overutilization or over treatment of a member for the purpose of increased provider revenues has no place in our network, and we will not tolerate abuse of position to our members’ physical or mental health and wellbeing for their gain.
Affordability and collaborative commercial relationships
At Allianz, we believe that payers and providers are part of a commercial ecosystem – but without members and patients, neither payer nor provider can develop their business interests.
Providers’ ethos of improving the healthcare outcomes of their patients and communities should begin with ensuring affordability, to enable members/patients to obtain affordable access to care – the first step on the journey of improved healthcare outcomes is to enable people to access the appropriate treatments, preventative measures and wellbeing services. Provider-led affordability allows payers, in turn, to offer affordable coverage for insured members to access care; the greater the affordability, the greater the opportunity for the provider to reach a larger population and achieve meaningful impact to their communities, as well as increasing their revenues to ensure continued investment in next-generation treatments and preventative measures.
We seek commercially responsible partners in our network – providers that play fair and respect pricing structures, providers that price their services appropriately, and in a fair and equitable manner, providers that offer the right level of care for our members, providers that establish credibility and are rewarded by greater engagement with us, and that wish to establish a long-term mutually beneficial relationship.
Digital engagement leads to ease of doing business
The transformation of the healthcare ecosystem may have been late to the party, relative to other sectors, but it is well and truly underway, and we, as a global leader, are looking for partners that have the ability, and most importantly, the willingness, to meet us, and travel with us on our digital journey.
We are interested in providers that have digital capability, embrace portals and other self-service tools to help provide best-quality service to members; providers that follow processes and procedures to expedite the patient ‘processing’ times – be it for eligibility, pre-approval or discharge and billing – to improve the member experience. Furthermore, we are seeking providers that actively engage with us all the way through the patient journey, and that will support us with open case management activities, providing us with the information we need to quickly enable the providers to deliver services to our members. Processes are an essential part of a successful partnerships – strong internal operational and financial processes ensure continuous collaboration, avoiding unnecessary reconciliation issues. What we want, ultimately, are providers that engage with us, and our members, digitally, in a way that allows the patients to focus on their health, not their administration.