Reducing Friction for Providers: Four Plays for Simpler, Faster, and Less Work

Improving provider experiences doesn’t have to be a long and complex process. The best outcomes are achieved through holistic plans that address the entire journey – enabling states to preserve and grow their network. Gainwell Technologies’ work with Medicaid agencies across the country reveals four key strategies for reinventing provider experience:

1. Get Enrollment Right the First Time
2. Simplify the Revalidation Process
3. Empower Providers Throughout the Process
4. Use Provider Feedback to Continually Innovate

Get Enrollment Right the First Time

Provider enrollment is often time-consuming and complex. Our analysis shows that providers typically navigate several clicks or pages before reaching the enrollment application, which can take up to two hours, 18 steps, and 150 fields to complete. This complexity often leads to errors and resubmissions.

Strategies to Create Frictionless Enrollment:

• Develop Pre-enrollment Checklists: These checklists detail the information needed for each enrollment, provider, and specialty type, helping providers start the application process prepared.
• Modernize the Portal Experience: Providers expect modern, customer-centric portals. A modern portal with dynamic applications can auto-fill previously entered data, reducing duplicate data entry.
• Streamline Attachment Requirements: Reduce the number of required attachments and restrict application submissions until all necessary attachments are uploaded.
• Adapt Applications to Individual Users: Use templates to speed up data entry and implement auto-adjudication for simple application types.

Simplify the Revalidation Process

Revalidating enrollment every three to five years is taxing, especially for large practices, facilities, and hospitals. The process can lead to the termination of non-responsive providers and difficulty revalidating all providers within the required timeframe.

Strategies to Simplify Revalidation:

• Facilitate Bulk Enrollment and Revalidation: Automation of several enrollments at once allows for quick processing and eliminates the time-consuming process of single provider updates.
• Access Medicare Provider Information: Use the Medicare Provider, Enrollment, Chain, and Ownership System (PECOS) to lighten the administrative burden of duplicate data entry.
• Remove Unnecessary Requirements: Streamline the process by removing unnecessary provider agreement and attachment requirements.

Empower Providers Throughout the Process

The Medicaid enrollment process can feel like a black box. Intuitive tools, enabling technology, and effective communication can give providers more control and improve visibility into the process.

Strategies to Empower Providers:

• Promote More Transparency: Allow providers to track the status of their application after submission.
• Extend Self-Service Capabilities: Improve portals and user interfaces to deliver a self-directed engagement experience.
• Leverage Existing Data: Use existing data to eliminate the need for applicants to re-enter information.
• Use AI to Predict and Eliminate Risk and Errors: AI can classify providers based on their interactions with enrollment systems to predict their expected experiences and avert adverse experiences.

Use Provider Feedback to Continually Innovate

Providers’ needs are constantly changing. Medicaid agencies must adapt their systems and processes in line with a deep understanding of these needs.

Strategies for Continuous Innovation:

• Create a Feedback Loop: Use advanced analytics and self-service tools to translate insights into innovation.
• Engage Providers in Development: Host provider user groups and engage providers and state leaders in the iterative process of creating better experiences.

Reduce Complexity, Improve Lives

Medicaid providers are driven by the desire to positively impact their communities. They should not have to choose between this commitment and the administrative burden of participating in the Medicaid program. By embracing intelligent provider solutions, human-centered design, and feedback loops, state Medicaid agencies can drive meaningful change and improve healthcare outcomes. The moment for innovation is now.

To learn more about these strategies and how they can transform provider experiences, we invite you to read our comprehensive white paper. It offers detailed insights and practical steps for implementing these plays in your organization. Download the white paper today to start your journey towards simpler, faster, and less work-intensive provider processes.