Four Hidden Pitfalls of In-House Provider Portals

Provider engagement is the backbone of aligning health plans with their provider networks, ensuring efficient operations, regulatory compliance, and high-quality care delivery. Yet, in today’s dynamic healthcare landscape, provider engagement professionals are juggling an ever-growing list of responsibilities—from staffing shortages and high turnover rates to the pressures of meeting value-based care goals and Healthcare Effectiveness Data and Information Set (HEDIS®) measures to managing data security. These demands often stretch resources thin, making it harder to focus on strategic initiatives that drive value for health plans and their provider networks.

One way to help alleviate these pressures while maximizing time and effort is by rethinking the technology that supports provider engagement. For health plan executives, transitioning from an in-house provider portal to a multi-payer platform offers an opportunity to streamline operations, reduce inefficiencies, and refocus resources on higher-impact priorities.

This blog details the four most significant challenges to developing, maintaining, and securing homegrown provider portals, and highlights some of the key benefits of switching to a multi-payer solution.

Breaking Down the True Costs of In-House Provider Portals

While managing an in-house portal may initially feel like the cost-effective choice, this mindset often underestimates what is truly involved in maintaining such systems. A closer examination reveals that this approach frequently leads to unforeseen challenges that can hinder growth and innovation, including:

Hidden Costs

Beyond the initial costs associated with developing the in-house portal, additional expenses emerge over time as organizations grapple with:

• Ongoing Development and Maintenance: Evolving healthcare regulations, payer-provider interoperability mandates, and user expectations require continuous updates. These updates demand specialized IT teams and a substantial budget.

• Compliance and Security Requirements: Ensuring the portal complies with HIPAA, HITECH, and other security standards requires constant monitoring and software patches. Additionally, implementing robust encryption protocols adds another layer of costs.

• Technical Support: In healthcare, downtime damages provider trust, results in financial losses, and most importantly, can have adverse effects on patient care. For this reason, it is critical to maintain 24/7 operational reliability, which requires staffing for IT support and emergency response.

Scalability Issues

The demand for interoperability, intuitive user interfaces, and real-time data access in healthcare presents major challenges for homegrown solutions. These custom-built systems often struggle to keep pace with evolving industry standards and user expectations. As a result, scalability becomes a recurring issue, with common problems including:

• Integration with New Technologies: Legacy systems may struggle to incorporate advanced tools like AI-powered analytics, telehealth integrations, or Fast Healthcare Interoperability Resource (FHIR®)-based standards for data sharing.

• Growing User Base: As provider networks expand, the portal must accommodate more users without sacrificing performance. This challenge often requires expensive system overhauls.

Security Risks

With cyberattacks rising in healthcare, data security is a top priority. Multi-payer portals offer robust, centralized security features, while homegrown solutions can leave your organization vulnerable to:

• Resource Constraints: Limited resources make it difficult to implement the same robust security measures that multi-payer platforms can offer.

• Fragmented Security Protocols: Without centralized oversight, homegrown portals can become a patchwork of vulnerabilities, exposing critical data to breaches.

Lost Opportunities

Developing, maintaining and securing a provider engagement portal is a full-time job. Payers with homegrown portals are solely responsible for managing that day-to-day work, leaving little time, energy, and resources for more mission critical or innovative initiatives. This can lead to:

• Reduced sustainability: The most effective payers are consistently thinking about how they can operate more effectively and efficiently. Tying too many resources up in maintaining a home-grown portal may limit opportunities for forward-thinking enhancement and development.

• Reduced member retention: Members are becoming more knowledgeable about what they want and need out of a health plan. Payers must be able to respond to those wants and needs. The more energy the payer can dedicate to thinking and acting strategically, the better. However, this becomes difficult when resources are tied up managing a home-grown portal.

The Availity Essentials™ Multi-Payer Solution Advantage

The decision to transition from an in-house provider portal to a multi-payer platform isn’t just about reducing costs—it’s about embracing a solution that supports scalability, enhances security, and fosters stronger provider relationships. To combat common challenges and improve provider collaboration, payers should consider the benefits of switching to a multi-payer solution like Availity Essentials™ as their provider portal.

In addition to freeing up internal resources to focus on mission-critical activities, our multi-payer platform leverages the power of Availity’s vast network. This platform offers a streamlined, secure, and scalable alternative that delivers:

• Cost Efficiency: With shared infrastructure and resources, health plans reduce operational expenses. They also benefit from continual upgrades, innovations, and ongoing product training and communications.

• Advanced Security: A centralized security framework ensures consistent protection of sensitive data across multiple payer networks.

• Improved Provider Experience: Intuitive interfaces, interoperability with third-party systems, and faster data access enhance provider satisfaction and reduce administrative burdens.

• Reclaimed Resources: By outsourcing portal management, health plans can redirect their IT resources to mission-critical activities. This includes care management, member engagement initiatives, or projects that drive innovation.

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Stay tuned for additional blogs in this series, where we’ll dive deeper into common provider portal migration myths. We’ll also explore the tangible financial and operational benefits of switching to a multi-payer solution.