Demystifying US Healthcare Part 3

Demystifying US Healthcare Part 3

Reimagining Provider Network Management

Saru Seshadri Founder & CEO

By Saru Seshadri, Founder & CEO, May 2023

Saru Seshadri Founder & CEO

By Saru Seshadri, Founder & CEO, May 2023

During my first hospitalization, which lasted for seven days, I was transported by ambulance due to the severity of my symptoms. This occurred before Covid-19 vaccinations were available, and the hospital followed the basic protocol to provide thorough treatment throughout my stay. However, upon returning home, I was surprised to receive a bill totaling $180,000. Fortunately, a significant portion of the amount had already been negotiated with contracted rates. Nevertheless, I was caught off guard by two additional unexpected bills from providers, amounting to $1,425. One of these bills was for a provider who hadn’t even visited me during my hospitalization. These surprise bills directly resulted from the fact that the physicians involved were not part of my insurance network.

This experience highlights the importance of utilizing healthcare providers who are within my insurance network and understanding the implications of network coverage. On average, seeking care from out-of-network providers in the United States can cost around $700, with pregnancy-related visits averaging around $2,000 [Fendrick].

It is crucial to consider these factors and make informed choices when it comes to healthcare to avoid unforeseen financial burdens.

Given my personal experiences, I have developed a strong interest in healthcare Provider Network Management. In previous blog posts, I have highlighted the importance of Provider Network Management and the challenges it can cause. Now, I would like to share my proposed solutions for addressing these challenges.

Reimagining Provider Network Management is of utmost importance for health plans. The accuracy and efficiency of these processes have a significant impact on care quality, cost management, and patient satisfaction. In a 2019 survey, it was found that providers spend a staggering $2.76 billion annually on maintaining provider directories. This further emphasizes the crucial role Provider Network Management plays in today’s healthcare landscape. At Constellation4, we offer a comprehensive suite of solutions to address these challenges. Below highlights our solutions.

Provider Data and Network Management
Provider Network Management With Constellation4
Provider Network Management simplifies the complex task of establishing and maintaining a network of healthcare providers that meet the needs of patients and health plans. Payers and providers can transparently communicate with the reassurance of accurate, up-to-date provider information. Our dedicated Provider Network Management solution offers a wide range of features and benefits:
Robust Network Building
Constellation4 provides powerful tools to help healthcare payers build and expand their provider networks. From identifying suitable providers to streamlining the contracting process, our solution simplifies network development.
Network Optimization
Ensuring that provider networks are optimized is essential for efficient care delivery. With advanced analytics and reporting capabilities, Constellation4 enables organizations to assess network performance, identify gaps, make data-driven decisions, and enhance network efficiency. These insights help optimize network utilization and drive strategic initiatives.
Contracting and Credentialing
Managing contracts and credentialing processes can be time-consuming and error-prone. Constellation4 automates these tasks, ensuring accurate, up-to-date, and compliant contracts that meet regulatory requirements.
Centralized and Real-Time Data
Our platform provides a centralized repository for storing and managing provider data. This eliminates data silos and reduces duplication, ensuring accurate and standardized information. Automated processes and interfaces continuously refresh provider data, reducing administrative burdens and improving data accuracy.
Compliance and Reporting
Compliance with regulatory requirements is vital in healthcare. Constellation4’s solution includes built-in compliance checks and reporting functionalities, helping organizations maintain adherence to standards and streamline audits. Our platform offers the flexibility to accommodate regulatory changes without disrupting operations.
Seamless Integration with Salesforce
By integrating with Salesforce, Constellation4 offers a flexible and customizable solution tailored to specific requirements. Healthcare payers can access comprehensive provider information, contract details, and communication history within Salesforce, fostering stronger relationships and personalized experiences. This integration optimizes provider networks, streamlines operations, and delivers exceptional care experiences.
Peace of Mind

With Constellation4, healthcare organizations have a dedicated team of professionals specializing in setting up and managing provider networks. Our engineers handle all technical aspects, ensuring a smooth implementation and ongoing management of the solution. This eliminates the need for health plans to invest time and resources in building their own teams and saves costs associated with recruitment, training, and overhead expenses. Healthcare payers can focus on their core mission of providing quality care.

In conclusion, Constellation4 offers a comprehensive solution for Provider Network Management, addressing the challenges faced by healthcare payers. Our robust network-building tools, advanced analytics, automated contracting and credentialing processes, centralized and real-time data management, compliance checks, and seamless Salesforce integration empower healthcare organizations to optimize their networks, streamline operations, and deliver exceptional care experiences.

By choosing Constellation4, healthcare payers can reimagine and enhance their Provider Network Management, ultimately improving the quality of care, cost management, payer-provider communication and overall patient satisfaction.

If you have any questions regarding how Constellation4 can assist your company, please email us at info@constellation4.comorcontact us on our online form. 


ChatGPT, personal communication, May, 2023

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