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by Matthew LaGanke, Executive Recruiter: Healthcare Compliance and Regulatory Affairs

This article was originally published on LinkedIn- [View Original Post]  

Third-party vendors have proven to be an invaluable resource for many health plans looking to cut costs on services and bring value to their organization. While these services provide many benefits, they often bring just as many stressors for a compliance program of a health plan, as these vendors are held to the same compliance standards as the contracting organization by CMS.

Speaking with leaders of compliance programs across the country, it’s clear that this is a common issue for all managed care organizations. They have shared with me their strategies for alleviating the pain points of third party vendors. A few common themes have emerged:

  1. Identifying vendors: The entirety of your organization should be aware of the vendors and the services that they perform for you.
  2. Setting the stage when deciding to use a vendor: Before delegating services out, a pre-audit should be performed to identify areas of concern from a compliance and quality standpoint. Vendors work with organizations all across the country; they would prefer to keep a consistent contract and process across all clients, but your organization is going to be unique in regulatory requirements due to several factors, including location and lines of business.
  3. Meeting frequency: While, per CMS or NCQA guidelines, reports may only be required on an annual basis, the meeting frequency of vendors and clients should be more regular to identify areas of non-compliance and risk. This should be written into the contract. At these meetings, there should be mock audits and reports prepared to ensure that any issues can be identified ahead of time to avoid long hours with deadlines looming.
  4. Account Executive relationship: Make sure to establish an open line of communication with the vendor account executive for your organization. Set expectations at the beginning of your business relationship that your vendors will have the same quality as your internal organization. However, don’t leave these guidelines vague. Providing vendors with the same specification and tools that you use to measure your own organization’s compliance will create a standard across the board that both the vendor and client can compare success with.
  5. Ongoing monitoring: This relationship is dynamic and will require continuous auditing, annual performance review, and Corrective Action Plans if necessary.

While these are some of the prevalent strategies that I’ve discovered across the industry, I’m curious about what other efforts you’ve found effective. How has your health plan successfully overcome the stress of third party vendors?


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