Navigating the Provider Network: Managing Contracts During a Global Pandemic

Sunil Masand

Sunil Masand

VP, Healthcare & Life Sciences Industries

According to the most recent data from the World Health Organization (WHO), there were roughly 313 million operations around the globe in 2012, an increase of 38.2% from an estimated 226.4 million operations in 2004. Among those operations, elective surgeries like cataract removal, joint replacement, Lasik, and cosmetic surgeries made up the majority. And the Centers for Disease Control and Prevention (CDC) reports that 84.3% of adults had contact with a health care professional in the past year.

Since the onset of the novel coronavirus pandemic, elective surgeries have been delayed and routine care visits are largely on hold, which is troubling given that elective surgeries and routine care make up nearly 50% of hospital revenue. In addition, lockdown and population safety concerns are resulting in lower hospital admissions in other departments (just look at Stanford Health Care’s recent report of a 40% reduction in emergency room visits). Revenue pressures faced by hospital systems are alarming, and the downstream impact results in provider staff pay cuts, reduced hours, suspensions, and terminations.

On the other hand, as health care professionals shift their focus to critically ill COVID-19 patients, there are increased flexibility demands for providers and care givers to expand their scope of services to include pandemic/hazard care, vaccine research, and treatments.

The Effect of COVID-19 on Provider Agreements

“Providers” as a category comprises of hospitals, hospital systems, nurses, caregivers, physicians, practitioners, lab technicians, and any staff that helps deliver care. COVID-19 has forced this ecosystem to react to a great deal of change in a very short amount of time. Just as quickly as provider contracts are being suspended, amended, and terminated, new staffing service contracts are popping up. These new arrangements require the rapid enablement of key processes such as provider onboarding, credential verification, fee schedule and rate negotiation, in addition to the assembly, redlining, and finalization of terms and clauses that go into the provider agreement.

Amidst this commotion, it is essential that healthcare entities contracting with providers do not lose sight of the regulatory laws that dictate adherence to fair market value (FMV) norms for contracted services. Because of oversupply and, in some cases, shortage of care providers, FMV benchmarks may need updating to factor in the pandemic landscape. Pay cuts, reduced hours, expansion of covered services, and a switch to remote/video patient visits all demand rapid mass updates and amendments to existing agreements, while still maintaining traceability as well as regulatory and legal compliance.

Provider agreements often contain obligations, such as performance standards related to quality of care, record keeping, credentialing upkeep, and compliance with regulatory provisions like HIPAA guidelines and anti-kickback laws. Certain provider agreements may require employer obligations, like providing an office/space and equipment, to be included in the agreement. However, some obligations won’t be met or might be at risk because of the pandemic.

In addition, some obligations extend beyond the life of the provider agreement, like the completion and submission of medical records and cooperation with transfer of practice patients. Payers and providers need to easily extract and track compliance against such post-contract termination obligations. At the end of the day, provider agreements must be easily searchable to detect agreements with obligation exposure terms and rapidly amended to relax, modify, or monitor obligations accordingly.

Preparing for the Return to ‘Normal’

If there is one thing the global pandemic has taught the provider network, it’s that the ability to act with agility across a wide spectrum of contract management processes is critical for business continuity and success.

Key capabilities that ensure such agility include the ability to:

Efficiently set up and deploy new agreement templates for new staffing and care-giving models, pandemic and hazard care, and other unforeseen situations that may arise in the future – all without system downtime of contract management solutions in place.

Setup new onboarding and approval workflows on the fly that accelerate the contract creation and activation lifecycle, then quickly apply these workflows to new and existing agreement templates without system downtime.

Rapidly search for agreements with specific terms and clauses to satisfy a variety of needs from obligation exposure management to enablement of operating and staffing model changes.

Apply and execute changes such as fee schedule updates, clause replacement, and obligation relaxation updates to agreements in mass while maintaining auditability and compliance.

Provide access to executed agreements to all parties, business associates, and stakeholders through a centralized, secure, and collaborative environment.

Accelerate the contract creation, negotiation, and activation lifecycles through a secure solution that encourages real-time collaboration and eliminates the need to transmit redlines and documents electronically or manually.

We are living in uncertain times and the ripple effect of the pandemic will continue for years. Not only do businesses need to protect themselves when the second wave hits, but also equip themselves to guarantee an efficient and smooth transition when agreements are reinstated and amended as the world returns to the new “normal.” Yes, cost pressures are high, but investments in robust and mature contract management solutions are warranted, and the benefits far outweigh the spend.

Conga offers Apttus Contract Lifecycle Management (Apttus CLM), an end-to-end contract management solution that ends the era of manual and disjointed contract processes and delivers higher-quality experiences for both internal and external customers. Our Apttus CLM solution adapts extremely well to the needs of the healthcare industry and enables hospital networks, healthcare payers, and other healthcare organizations to drive the optimal provider network from source to contract and empower themselves with the ability to engage, credential, onboard, and contract with agility. CLM Accelerators complement the Apttus CLM solution and ensure faster time-to-value for your CLM deployment – an absolute must-have in times that demand business agility.

 

Check out a demo or schedule a meeting with an Apttus CLM expert to learn more about our provider offerings.

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