As we discussed, in Part 1 of this two-part series, keeping up with provider data management is tedious and time-consuming for all involved. Payers see an abundant amount of data from providers that are crucial to the success of both entities. When something goes wrong related to provider data management, payers are often the first to be blamed. For this reason, it’s important for payers to position themselves as a partner to providers — not a burden.
Ultimately, the solution for payers lies within their data management and exchange processes. Whether the solution is to work with a partner like a clearinghouse or to build an internal team, there are a few key elements to a successful provider data management solution that payers should consider. With the right approach to structuring and managing provider data, payers can drastically help improve provider data exchange to boost patient satisfaction and clinical outcomes for providers.
Develop a Central, Organized Hub for Data
Both payer and provider organizations, large and small, struggle with having one central hub for all data. A big chunk of time for staff on both sides in performing administrative tasks goes into finding data, updating files, and cross-referencing data across many sources. One solution to the data flowing across health systems is to have one central repository for all data — a singular place where all data lives to ensure the best source of information lessening the time an individual is searching for data.
In order for this repository to be effective at managing data, it must be upkept constantly. This means that payers have to make it easy to collect data without it having to be attached to a specific provider event or transaction. For example, at Madaket we separate profile (static or demographic) data from transactional data. That’s because data like an address or zip code needs to be timelier than data that are only associated with an infrequent transaction like credentialing or primary source verification. This ensures that users don’t have to dig through old transaction details to find simple things like addresses, emails and phone numbers that are needed for directories.
Additionally, repositories need to store data in a way that eliminates duplication. Most payer and even intermediary systems store data by the organization, not the provider, leading to multiple entries per clinician that staff often have to cross-reference. We’ve created hierarchical data that ensures that each clinician is represented only once in our system and that all associated data rolls up to the singular profile cutting down on duplication.
Create Bidirectional Data Share
Many payers think they’ve solved the central hub issue with portals, but as many of them would also admit, the portals aren’t perfect. Portals are good means for data input, but without a bidirectional flow, they do not work to create seamless data use. Integrating portals that can both push and pull data from payers, providers, and even intermediaries or clearinghouses can help keep data as clean as possible. With consistency and free-flowing information, crucial tasks that lean on accurate, up-to-date provider data such as provider enrollments, payer credentialing, or directory updates, become much more manageable for everyone.
Don’t Just Store Data — Analyze It
Collecting data centrally and storing data in a more structured way is just the start. Data is meant to be analyzed for insights into better processes that ultimately lead to business improvement. By looking at data in the aggregate, providers and payers alike can see the bigger picture. Plus, with bidirectional data-sharing, powerful analytics can look not just within one payer organization or provider organization, but rather across many organizations.
For example, one health plan parent brand could look across all its sub-brands to see how often provider information is changing to support improved directory and network validation. Providers utilizing this level of analytics could have more visibility into their clinician onboarding processes and even benchmark themselves against others. Detailed analytics of provider data management and movement can help the industry, organization by organization, institute more efficient processes to chip away at the $16.3 billion in potential savings from eliminating administrative waste.
Data is at the center of everything we do in healthcare, whether it’s patient vitals, EMRs, or in this case, the mundane provider data that helps to fuel the business side of healthcare. The sooner that payers and providers can embrace the trends at hand in provider data exchange, the easier it will be to foster productive relationships between the two entities so that they may both focus more energy and resources on providing exceptional care to their patients and members.