Despite healthcare’s rapid digital transformation, provider network management (PNM) remains one of the most fragmented and inefficient domains for payers. According to a key finding in the 2025 Gartner® Market Guide for U.S. Healthcare Payers’ Provider Network Management Applications,” many healthcare payers have a siloed, fragmented — and sometimes homegrown — approach to provider network management (PNM), hindering experience, efficiency and efficacy. Payers need a holistic end-to-end strategy and supporting technology — or set of technologies — to effectively manage provider relationships.”1

Why Provider Network Management Matters

PNM solutions are critical to providing members high quality, accessible and affordable care. They integrate data sharing, workflows and contractual obligations across the full provider relationship lifecycle — from network design and onboarding to claims payment, servicing and contract renewal.1

PNM is the connective tissue between payers and providers. When it’s fragmented, everyone feels the pain: members face lack of access and surprise billing, providers experience onboarding delays and payers struggle with compliance, cost containment and competition.

The Hidden Costs of Fragmentation

The consequences of outdated PNM systems are well-documented:

  • Operational inefficiencies: Disconnected systems hinder network development and slow provider onboarding, while adding unnecessary administrative tasks. These added burdens reduce the time and attention providers can devote to patient care — making it harder to serve members. According to the Agency for Healthcare Research and Quality (AHRQ), fragmented care coordination — often exacerbated by administrative demands — leads to worse outcomes, especially for patients with chronic conditions.2
  • Data inaccuracy and compliance risks: Disconnected systems often result in duplicate records and outdated provider information. CMS’s NPPES and PECOS systems were created to address these very issues by centralizing provider data and improving accuracy — with mixed success.
  • Limited access to care: Without a unified approach, payers risk falling short of standards that ensure members have enough choice in providers. In today’s competitive landscape, strong networks aren’t a nice-to-have — they’re essential to member satisfaction, regulatory compliance and long-term success.3

Rise of Total Experience (TX)

Gartner recommends adopting a Healthcare and Life Sciences Total Experience (HCLS TX) strategy, “and embrace a perspective that involves multiple stakeholders —- provider, employee, business and member — when identifying the features and capabilities needed to support your PNM and the broader provider data management (PDM) and credentialing strategy.”1

How to Deliver TX-Driven Value

Many payers are seeing the benefits of TX — from faster onboarding to stronger provider relationships — through:

  • Automation and AI: Intelligent tools — including provider contract assistants and GenAI-powered chat — reduce manual work, improve accuracy and accelerate onboarding. CMS’s iQIES platform demonstrates how automation has streamlined quality improvement and reporting.
  • Real-time data and analytics: Analytical insights help payers identify trends, forecast performance and ensure network adequacy. “Actionable, aligned data — not just volume — drives success.”3
  • Enhanced collaboration and transparency: Successful solutions foster a simplified, transparent process between payers and providers. Don’t just digitize workflows —humanize them. Because “People — not just technology — drive successful networks”.3

Strategic Outcomes That Matter

The business case for TX-aligned PNM is clear.

Zelis clients are already seeing these results. By unifying fragmented systems and enabling real-time collaboration, we help payers move from reactive to proactive — from fragmented to fluid.

What Payers Should Do Next

Payers can take a look at their current PNM capabilities and ask: What’s working? What’s not? And what’s the cost of doing nothing?

At Zelis, we help our clients do exactly that kind of questioning — with built-in analytics and benchmarking tools that make ROI visible and actionable.

Industry Recognition

Zelis is proud to be named a Representative Vendor in the 2025 Gartner Market Guide for U.S. Healthcare Payers’ Provider Network Management Applications.

Why Zelis Leads in PNM

Zelis is more than a technology provider — we’re a strategic partner in your transformation journey. Our Provider Network Management solutions meet you where you are, from foundational network analytics to building custom networks tailored to your population’s needs. From there, we help fill gaps via access to partner networks and scale up to advanced analytics and data management. It’s all designed to support the Total Experience — not just as a feature, but as a foundational design principle.

We believe that when payers, providers and members are all empowered with the right tools and insights, everyone wins.

Click here to learn more about Zelis Network Solutions.

References

1. Gartner, “Market Guide for U.S. Healthcare Payers’ Provider Network Management Applications.” Gartner, June 2025. ID G00788083.

*Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally and is used herein with permission. All rights reserved.

2. Agency for Healthcare Research and Quality. “Care Coordination.” U.S. Department of Health and Human Services. ahrq.gov/ncepcr/care/coordination/mgmt.html

3. American Medical Association. “Hold Health Plans Accountable for Physician Network Inadequacies.” AMA, https://www.ama-assn.org/health-care-advocacy/access-care/hold-health-plans-accountable-physician-network-inadequacies.