How Health Plan Providers Optimize Performance with Contract Lifecycle Management

As companies mature, the number of stakeholders involved in and the complexity of the contract process increases dramatically. This is particularly true for commercial health insurance organizations that manage thousands of contracts across provider recruitment, member enrollment and claims processing. Without a contract lifecycle management (CLM) solution to tame this complexity, health insurers are faced with manual contract processes that waste time, and lead to unnecessary risk and dissatisfaction for providers, members and employees.  

In this post, we’re going to explain what a CLM platform is, what provider contracting abilities it gives you as a health plan and how those new abilities translate into better business results for you, your participating providers and your health plan members.

A better way to manage provider contracts

A CLM platform is a software-as-a service application that a health plan would license to automate manual contract workflows, streamline preparation and negotiations, centralize, store and electronically manage all contracts throughout the entire life cycle of each contract. The first challenge simply is trying to get a handle on the sheer number of provider contracts that you have. That number can be in the thousands, tens of thousands or even hundreds of thousands, depending on the size and market reach of your health plan. 

The second challenge is trying to manage the redlining, versions, and reviews of each of those contracts, which may be in varying stages of completion or approval, include non-standard contract terms or based on out-of-date language. 

The third challenge, which really is the consequence of the first two, is compliance. If you don’t know how many provider contracts you have and whether each one is completed, up-to-date and executed properly, you run the serious risk of being out of compliance on a number of levels.

Visibility, control and compliance

So how does moving to a CLM platform that handles all your provider participation and reimbursement contracts solve those three challenges? It gives you visibility. It gives you control. And as a result, it streamlines compliance processes.

Let us explain each of those in more detail.

CLM gives you visibility. When you digitize all your provider contracts and store them in a centralized database, you gain visibility to answer key contract questions such as:

  • Whether you have a contract with an individual provider
  • Whether the terms of the contract is right for that provider
  • Whether that contract is completed or needing renewal 

Not only can you do those three things in a more streamlined manner through AI technology with one provider, you can do them with hundreds or even thousands at a time. You can initiate, terminate or replace a contract with a provider or complete an unfinished contract so you and your participating provider can execute on its service and payment terms. 

CLM gives you control. Here we’re talking about contract control, version control, access control and approval control. A CLM solution doesn’t just tell you a contract is incomplete, it alerts you if specific clauses differ from the approved contract language provided by your legal department. That includes leveraging a library of pre-approved clause language that automatically appears when negotiating contract language. Version control means only one version of the contract exists at a time and redlining changes are captured in real-time in a single version. There aren’t multiple versions in email attachments and file folders. Access control means you decide who gets to see the contract and who gets to revise the contract. Approval control means you decide who approves the contract and whether that approval is final.

CLM helps streamline compliance. When all your participation and reimbursement contracts with your providers are complete and up-to-date, you can more easily manage compliance on three levels: regulatory compliance especially with Medicare Part D, transactional compliance by you and your providers with the terms of the contract; and corporate compliance with your own health plan’s financial reporting and governance rules. 

Better business results for you

Operationally what you’re doing is streamlining your entire provider participation and reimbursement contract process. You’re making it more efficient. You’re making it more accurate. You’re making it less expensive. And, you’re making it more secure from a privacy standpoint by controlling versions, access and approvals.   

Beyond reducing your operating expenses related to your provider contracting process, you’re accruing other financial benefits. At the top of that list is contract compliance. You know the financial terms and now you can continuously monitor whether you’re reimbursing each of your participating providers the right amount based on their compliance with the service terms in their contracts.

That’s even more important now as value-based reimbursement contracts grow in number and complexity. Your CLM platform doesn’t collect and analyze quality measures from your providers under contract. But, after you integrate your CLM platform with your provider performance systems, you can better track provider performance against contract requirements for more accurate payment.

Another financial benefit is better collaboration with providers. By leveraging a CLM solution, you offer providers a better experience to do business with you whether that’s a straight forward fee-for-service contract or a complex value-based care contract. That will help you attract and retain the right providers that you want in your networks and that, in turn, will attract business from employers, members and other payers. 

Better experience for members

Switching to a CLM platform to manage your provider contracts makes it easier to automatically check the license and credentialing status of each provider under contract. You can quickly verify that each provider is licensed to practice medicine in the state where your members receive care and credentialed in the medical specialty that they practice.  The system can flag missing or out-of-date licenses and credentials and ask providers to submit updated documents.

Health plans can also leverage a CLM platform to streamline the assembly of provider directories and benefits booklets for members. Your directories and booklets will be up to date, enabling your members to see in-network providers for their care (versus out-of-network providers and face a big out-of-pocket bill) and to know what their benefits package covers in terms of medical services and prescription drugs.  

For instance, Docusign helped Aetna develop a seamless process to create, print, and store policy quotes and booklets with standard and customized language. After review is complete, Docusign CLM automatically sends the document to a 3rd party printer that produces and mails the booklets directly to Aetna Voluntary’s customers. A searchable, electronic copy of each booklet is tagged and stored within Docusign CLM for online access by customers and Aetna employees.

Think of a CLM platform as the provider contract workflow engine that can take you where your health plan needs go with your participation and reimbursement arrangements with providers. The time to get on board is now.

Learn more about Docusign’s contract management lifecycle solutions for health plans and payers.

Kelley Pidhirsky
Solution Engineering Manager