Relationship management in supplementary healthcare is fundamental when it comes to establishing solid partnerships with hospitals, clinics, laboratories and suppliers of hospital materials. Clear communication and well-defined agreements are essential for the quality of care and the reduction of conflicts.

Relationship management with service providers in the supplementary health sector is fundamental to guaranteeing the quality of care and the sustainability of operations. Health insurance companies, acting as intermediaries between beneficiaries and providers, have the challenge of building solid partnerships with hospitals, clinics, laboratories and suppliers of hospital materials. This strategic relationship seeks not only to guarantee the best possible patient care, but also to control costs, prevent conflicts and align interests between all those involved.

The importance of strong partnerships in the supplementary health sector

In a highly regulated and complex sector such as supplementary healthcare, solid partnerships with providers are essential. Unlike other areas, where the provider and client have a more direct and simplified relationship, the supplementary health value chain involves multiple stakeholders with different expectations and responsibilities. Operators and providers have complementary roles, but may face divergent objectives in financial matters, which makes investing in long-term relationships even more essential.

Establishing solid partnerships with providers such as hospitals, clinics and laboratories can result in significant improvements in care. In addition, these partnerships favor greater cost predictability, allow for the sharing of information on quality and patient safety and can result in more advantageous commercial conditions. In recent years, we have observed that operators who invest in strengthening their relationship with providers have lower rates of judicialization, conflicts and delays in payments, which strengthens the financial health and image of the operator.

 

Key elements for building effective partnerships

For the partnership between operator and provider to be effective, certain elements are essential. Below are crucial aspects for medical account managers looking to establish and maintain a constructive, long-term relationship with providers:

1. Clear and transparent communication

Transparent communication is the basis for a trusting relationship. Medical bill managers need to maintain open communication, where all parties feel comfortable discussing complex issues. Transparency means that both operators and providers know what to expect in terms of quality, cost and scope of services.

Clear communication is also essential to reduce conflicts and avoid misunderstandings, which are often the source of disputes and dissatisfaction between the parties. Aligning expectations and clarifying doubts allows operational and financial issues to be resolved more quickly and effectively.

2. Well-defined agreements and contracts

Formalizing agreements, preferably detailed in well-defined contracts, is essential for managing the relationship. Contracts should specify not only the amounts and payment deadlines, but also the expected quality parameters, the responsibilities of each party and the policies for dealing with disagreements or problems.

In addition, well-drafted contracts facilitate the process of auditing medical bills, allowing for a more precise and agile review of the services charged for. Agreements should include clauses that encourage continuous improvement and penalize abusive or non-compliant practices. A detailed contract is a tool to ensure that the partnership is fair, balanced and transparent.

3. Performance monitoring and evaluation

In order to guarantee the quality of services, it is necessary to implement mechanisms for monitoring and evaluating the performance of providers. Healthcare providers should establish quality indicators, such as waiting times, the return rate of appointments, beneficiary satisfaction rates, among others.

This data is essential for identifying opportunities for improvement and keeping the provider aware of its strengths and areas for improvement. Periodic evaluations and performance reports are valuable tools for operators, enabling proactive relationship management and favoring the resolution of problems before they become significant.

4. Conflict management

Even with clear agreements, conflicts can arise throughout the relationship between operator and provider. Establishing a conflict management protocol is a preventative measure that avoids unnecessary escalations. This includes defining who will be responsible for mediating situations of disagreement and what steps should be taken to resolve the conflict.

Effective conflict mediation, through clear channels and protocols, prevents small problems from growing, preserves the relationship between the parties and reduces the legalization of issues.

5. Investment in technology and data integration

Technology can play a crucial role in optimizing relationships with providers. Data integration platforms that allow patient information to be accessed more quickly and accurately contribute to the efficiency and safety of care.

In addition, provider relationship management (PRM) systems make it easier to monitor metrics and keep track of contractual information. Healthcare operators who invest in technology are able to respond more quickly to provider demands, making the partnership more efficient and transparent.

6. Alignment of interests and incentives

A good practice that can strengthen relationships with providers is to align interests through incentives. For example, operators can offer bonuses or differentiated payments to providers who achieve certain quality indicators, such as a patient satisfaction rate above an established target.

These incentives create a dynamic of cooperation, where both the operator and the provider are motivated to seek continuous improvement and meet quality targets. This type of practice helps to align financial and healthcare interests, benefiting the system as a whole.

7. Training and capacity building for providers

Continuous training of providers is an effective strategy to ensure that quality standards are maintained and that everyone is up to date with new regulations and guidelines in the sector. Many operators invest in training programs, workshops and courses for their partners, covering topics such as best care practices, patient safety, compliance and fraud prevention.

This investment in training not only benefits the quality of patient care, but also strengthens the relationship between operator and provider, demonstrating that the operator is committed to the development of its partners.

8. Periodic review of agreements

The supplementary health market is dynamic and constantly impacted by regulatory, technological and economic changes. It is therefore important for operators and providers to periodically review their agreements, adjusting them in line with the current reality.

This practice of periodic review is essential to maintain alignment between the parties, ensure that the terms of the contracts reflect the needs of both sides and avoid surprises or dissatisfaction. The review can include financial aspects as well as quality metrics and scope of services.

 

Learn about the solution adopted by dozens of healthcare operators across Brazil

Relationship management with service providers is one of the pillars for the success and sustainability of healthcare operators. Establishing solid partnerships with hospitals, clinics, laboratories and suppliers of hospital materials not only improves the quality of care, but also brings financial stability and reduces the rate of conflicts. These partnerships must be built on a foundation of clear communication, well-defined agreements and performance indicators.

Dozens of healthcare operators across Brazil use the SAUDI system, which makes it possible to medical bill audit automatically, efficiently, securely and in real time. Using the SAUDI system was the easiest way to put into practice most of the items presented in this article, such as: clear and 100% transparent communication, constant monitoring of all processes, etc. Using technology and encouraging continuous training are measures that demonstrate a commitment to excellence and contribute to strengthening the relationship between the parties.

SAUDI makes it possible to build and maintain a network of providers who are committed and well aligned with the operator's guidelines. This alone is a BIG competitive advantage for supplementary healthcare companies. Through strategic relationship management, operators not only guarantee the quality of care provided to beneficiaries, but also create a more sustainable and collaborative healthcare ecosystem. Talk to a SAUDI expert now and schedule a no-obligation presentation! ; )