By Norah Brennan, SVP of Product Development
Commercial network management is evolving. What was once viewed primarily as a contracting function is now inseparable from the member experience.
Members do not evaluate networks based on the number of signed agreements. They evaluate them based on whether they can schedule an appointment, whether a provider is truly in network, and whether the information they see online matches what they are told when they call. Employers measure performance in similar terms. Regulators increasingly do the same.
From my perspective, leading product development at HealthAxis, modern network management requires more than better contracts. It requires disciplined data governance, operational rigor, and technology that connects provider data to every member touchpoint.
The New Expectations
Today’s expectations are clear.
Members expect accurate directories, intuitive digital experiences, faster problem resolution, and consistent information across portals, call centers, and printed materials.
Not only employers, but the providers themselves expect predictable performance, fewer escalations, and reduced billing or access disputes that disrupt employee and patient satisfaction.
Regulators expect greater accountability for both accuracy and access. Directory accuracy and network adequacy are no longer passive compliance items. They are active oversight priorities.
What “Modern” Looks Like in Practice
Modern network management blends contracting discipline with strong operational and data foundations.
In practical terms, that typically includes:
- Structured provider data governance models with defined ownership, verification processes, and routine auditing
- Automation for routine updates and exception handling to reduce manual error
- Analytics tied to access and adequacy performance, not just contract volume
- Tight integration between provider data, claims, and member service systems
- Rapid change workflows to address network shifts, terminations, or policy updates without lag
When these capabilities work together, the network becomes a living system rather than a static file that is updated periodically.
The Operating Model Shift: From Projects to Continuous Operations
One of the most important changes I see across forward-looking commercial plans is the shift from periodic cleanup projects to continuous operational management.
Instead of treating directory accuracy as a quarterly initiative, high-performing organizations build ongoing measurement and accountability into their daily workflows.
That includes:
- Tracking defined directory accuracy indicators
- Monitoring complaint trends and failed appointment reports
- Shortening the time between issue detection and correction
- Establishing clear ownership across contracting, provider relations, operations, and member services
This shift requires cultural alignment as much as technical capability. It means recognizing that provider data is not just an operational asset. It is a core component of the member experience.
Why This Matters Now
Commercial competition increasingly centers on experience, not just pricing. Employers and members have more visibility into network performance than ever before.
When a directory is inaccurate or a provider status is unclear, the impact is immediate. It can lead to delayed care, unexpected bills, escalations, and reputational risk.
Conversely, when network information is accurate, integrated, and continuously maintained, plans build trust. Providers experience fewer administrative disruptions. Member service teams operate more efficiently.
Modern network management is no longer a back-office function. It is the front door to the health plan experience. For commercial plans looking to differentiate on service and reliability, strengthening this foundation is not optional. It is strategic.
