A health plan's most valuable resource is its provider network, but many organizations struggle in building and maintaining provider relations, and, more specifically, in recruiting and retaining providers. This is particularly true in Medicaid managed care, where historically low reimbursement rates have made recruiting a challenge, particularly for specialty providers. To identify barriers and solutions, the Association for Community Affiliated Plans (ACAP) conducted a study of its member plans in the spring of 2004, selecting four plans for in-depth case studies. The plans stressed the importance of two complementary approaches: sustaining relationships with providers through regular and meaningful communications and introducing technology applications to facilitate process improvement. Specifically, ACAP plan leaders experienced the greatest success in improving provider relations in the following five areas: 1) payment practices, incentives, and financial assistance; 2) utilization management; 3) communications and provider outreach; 4) practices to simplify administrative burdens; and 5) enabling services.
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