How Healthcare Payers Plan to Improve Provider Engagement in 2025

Effective provider engagement is fundamental to reducing administrative costs and improving member outcomes. However, as operational complexities persist and healthcare demands increase, the need for innovative approaches to provider engagement has become more urgent than ever.

Healthcare payers are now looking to the future, identifying new strategies, technologies, and processes to overcome challenges and move toward meaningful provider collaboration. Here’s how health plan executives are preparing to improve provider engagement in 2025.

Three Priorities Driving Provider Engagement Strategies

The HealthEdge® Annual Payer Market Planning Report 2025 offers critical insights into what health plan leaders are focusing on when it comes to provider engagement. The top three priorities include:

1. Provider Network Management (33%) – Streamlining network operations to improve efficiency and provider satisfaction.
2. Payment Integrity (22%) – Ensuring accurate, timely payments to build trust while minimizing costly errors and rework.
3. Enhanced Provider Collaboration and Value-Based Care (VBC) Contracting (19%) – Empowering providers to deliver better outcomes through partnership-driven models.

These priorities reflect a broader trend of moving from transactional relationships to collaborative ones, where payers and providers work together to achieve shared goals.

Overcoming Key Challenges in Provider Engagement

Despite the focus on improving provider networks and payments, health plans face several prominent challenges when it comes to provider engagement. Based on survey responses:

• Claims processing delays (60%) emerged as the leading issue, causing frustration for providers and slowing down administrative workflows.
• Limited access to real-time data and information sharing (45%) continues to hinder seamless collaboration.
• Lack of transparency (43%) negatively impacts provider trust and satisfaction.

Modern and integrated solutions are essential for health plans to tackle the challenge of real-time data access, identified by 71% of health plans as their biggest workflow and data communication issue. By ensuring interoperability and seamless data flow between healthcare systems, these solutions can significantly enhance provider engagement.

The Role of Provider Data Management (PDM) in Engagement

Central to streamlining provider relationships and overcoming challenges is the integrity and efficiency of Provider Data Management (PDM) systems. However, today’s market is saturated with disjointed solutions riddled with inefficiencies. Health plans often rely on scattered point solutions, fragmented systems, and subpar data integration.

For health plans looking to level up their provider engagement, modern solutions offer a holistic solution to these obstacles. Leaders in this space are prioritizing three main investments for their provider engagement solutions over the next year:

1. Enhanced Analytics and Reporting (24%) – Tools that provide actionable insights to improve performance and guide decision-making.
2. Real-Time API Services (23%) – Seamless, real-time interoperability to keep provider data accurate and accessible.
3. Self-Service Digital Resources (22%) – Empowering providers with user-friendly platforms to manage their data independently.

These features ensure that  have the tools necessary to streamline workflows, improve data accuracy, and boost provider satisfaction.

Payment Integrity as a Building Block for Provider Trust

One of the most impactful ways to improve provider engagement is by investing in payment integrity technology. Accurate payments, streamlined workflows, and reduced payment delays are critical to building trust with providers. Yet, many health plans still struggle with overpayments, underpayments, and drawn-out payment reconciliation.

HealthEdge Source Payment Integrity Suite offers a proactive solution. By integrating industry data, proprietary rules, and a flexible configuration layer, HealthEdge Source helps ensure accurate claim editing and pricing. With tools to reduce improper payments upfront and minimize rework, health plans can significantly reduce provider abrasion.

HealthEdge Source also has the ability to adapt provider contract terms and policy guidelines into the platform as a series of edits and pricers. This allows for precise business intelligence and deployment into production with minimal IT lift.

Real Savings Through Payment Integrity

• Time Efficiencies: Source’s workflow automation and real-time claims adjudication reduces manual hours spent correcting errors.
• Cost Savings: Preventing improper payments up front saves both money and resources.
• Provider Satisfaction: Efficient payment processes help maintain a positive payer-provider relationship.

Building Transparent and Collaborative Provider Relationships

In the report, 59% of executives surveyed agree that improving transparency in claims and payment processes is critical for provider satisfaction. Providers need access to the most accurate, up-to-date information to provide members with the right care.

HealthEdge’s integrated platform provides a vital foundation for these investments. Offering end-to-end solutions for everything from administrative processing and payment integrity to care management tools, the platform is carefully designed to tackle modern healthcare challenges while enabling health plans to collaborate effectively with network providers.

The path forward for healthcare payers depends on meaningful provider engagement. By prioritizing technology modernization, payment accuracy, and transparent collaboration, organizations can foster proactive partnerships that benefit both providers and patients.

Actionable Next Steps:

1. Evaluate your existing systems for efficiency and integration gaps.
2. Invest in integrated solutions that can provide analytics, real-time updates, and self-service capabilities to providers.
3. Adopt proactive payment integrity solutions to streamline claim workflows and build trust.

Improving provider engagement isn’t just a vision for the future—it’s an imperative for today. Health plans committed to innovation and collaboration will position themselves as leaders in an increasingly competitive industry.

Visit our blog, 3 Ways to Reduce Provider Abrasion with your Payment Integrity Solution.