The Path to More Accurate Provider Data

The following is a guest article by the Healthcare Business of LexisNexis® Risk Solutions.

Accurate provider data is foundational to the United States healthcare system. Healthcare professionals’ role in collecting and maintaining this data, including providers’ names, practice addresses, office hours, specialties, sanctions and hospital affiliations, is critical but also invaluable. It ensures timely patient access to care, automatic claim processing, network management, compliance, fraud detection, physician recruitment and more.

However, much of this provider data has a short shelf life. The Centers for Medicare and Medicaid Services reported more than 45% of provider office locations listed in online directories contained at least one error. The industry spends over $2.1 billion annually to maintain provider data, but the system is still inefficient and error-prone.

Roadblocks to accurate provider data

How difficult can it be to maintain accurate provider data? The question assumes that the data remains mostly unchanged and should be reasonably easy to maintain. However, reconciling, managing and maintaining accurate provider data can be monumental. There are three key reasons why.

First, provider data is continually changing. What’s true today may change tomorrow. Providers retire, relocate, practice at multiple locations, change surnames and make other changes. On average, 25% of providers have some change in information every 90 days. Compounding the situation is the ongoing industry consolidation as physician practices merge or are acquired by a hospital or integrated delivery system.

Second, integrating data from multiple sources, such as national databases, medical associations, health plans and provider organizations, can be complex and error-prone. Disjointed merging and linking of these data sources lead to inconsistent information, duplications and outdated information.

Finally, administrative complexity makes the stakes higher than ever to maintain accurate provider data. According to a 2018 American Medical Association survey, providers reported submitting directory information to health plans in various ways, including by fax (38%); credentialing software (13%); email (13%); provider management and enrollment software (5%); and phone, mail and other methods (14%).

A ”golden record” enables insights at the point of decision-making

Organizations that master provider data management benefit from a single source of data – a “golden record” – that has been integrated from various sources and applications into a more reliable and more accurate view of the provider. The result: better quality data that leads to better patient care and experiences, lower costs and improved efficiency.

As various technologies continue to evolve, we can look forward to an improved digital experience and health outcomes. A study (“What Physicians are Saying About Directories” American Medical Association, 2018.) published by the Journal of Medical Internet Research (IR) showed that patients rated providers with complete, accurate profiles more favorably.

We can also anticipate reduced costs. Mastering provider data management enables health plans and providers to maintain accurate and robust directories with lower costs and administrative burdens. Another benefit is improved operational efficiency. Up-to-date sanctions information supports healthcare organizations with hiring, credentialing, medication dispensing and reimbursement decisions.

Mastering provider data management is not easy. These five steps are essential to achieving a golden record.

1. Define your use case: Ensure you understand your business needs clearly and find the right balance between the number of records you need to enumerate in your system.
2. Align your data architecture: Confirm the right relationships between your data elements and records by aligning them with your user cases and how your downstream business processes and systems need to consume the data.
3. Identify critical data elements: Determine and prioritize critical data elements to manage your data more successfully.
4. Build and use your golden record: Define your data collection methods, sources of truth, and business rules and build out your data collection strategy for each business use case.
5. Refresh and validate your data: Cleanse and validate the entire master data management system regularly to standardize, clean, de-dupe and augment provider information.

Creating a golden record for your data requires significant time, effort and resources. But once you build it and have a solid strategy to maintain it, your golden record will yield a long-term return on your investment and a distinct competitive advantage.

Contact LexisNexis® Risk Solutions to unlock the power of data, insights and analytics to power next-generation healthcare technologies and platforms to enhance clinical research efforts, bolster patient engagement programs and much more.

About LexisNexis Risk Solutions

The Healthcare Business of LexisNexis^® Risk Solutions harnesses the power of data, sophisticated analytics platforms and technology solutions to empower healthcare organizations with critical insights to transform operations and create healthier communities.

LexisNexis Risk Solutions is a sponsor of Healthcare Scene.

The following is a guest article by the Healthcare Business of LexisNexis® Risk Solutions.

Accurate provider data is foundational to the United States healthcare system. Healthcare professionals’ role in collecting and maintaining this data, including providers’ names, practice addresses, office hours, specialties, sanctions and hospital affiliations, is critical but also invaluable. It ensures timely patient access to care, automatic claim processing, network management, compliance, fraud detection, physician recruitment and more.

However, much of this provider data has a short shelf life. The Centers for Medicare and Medicaid Services reported more than 45% of provider office locations listed in online directories contained at least one error. The industry spends over $2.1 billion annually to maintain provider data, but the system is still inefficient and error-prone.

Roadblocks to accurate provider data

How difficult can it be to maintain accurate provider data? The question assumes that the data remains mostly unchanged and should be reasonably easy to maintain. However, reconciling, managing and maintaining accurate provider data can be monumental. There are three key reasons why.

First, provider data is continually changing. What’s true today may change tomorrow. Providers retire, relocate, practice at multiple locations, change surnames and make other changes. On average, 25% of providers have some change in information every 90 days. Compounding the situation is the ongoing industry consolidation as physician practices merge or are acquired by a hospital or integrated delivery system.

Second, integrating data from multiple sources, such as national databases, medical associations, health plans and provider organizations, can be complex and error-prone. Disjointed merging and linking of these data sources lead to inconsistent information, duplications and outdated information.

Finally, administrative complexity makes the stakes higher than ever to maintain accurate provider data. According to a 2018 American Medical Association survey, providers reported submitting directory information to health plans in various ways, including by fax (38%); credentialing software (13%); email (13%); provider management and enrollment software (5%); and phone, mail and other methods (14%).

A ”golden record” enables insights at the point of decision-making

Organizations that master provider data management benefit from a single source of data – a “golden record” – that has been integrated from various sources and applications into a more reliable and more accurate view of the provider. The result: better quality data that leads to better patient care and experiences, lower costs and improved efficiency.

As various technologies continue to evolve, we can look forward to an improved digital experience and health outcomes. A study (“What Physicians are Saying About Directories” American Medical Association, 2018.) published by the Journal of Medical Internet Research (IR) showed that patients rated providers with complete, accurate profiles more favorably.

We can also anticipate reduced costs. Mastering provider data management enables health plans and providers to maintain accurate and robust directories with lower costs and administrative burdens. Another benefit is improved operational efficiency. Up-to-date sanctions information supports healthcare organizations with hiring, credentialing, medication dispensing and reimbursement decisions.

Mastering provider data management is not easy. These five steps are essential to achieving a golden record.

1. Define your use case: Ensure you understand your business needs clearly and find the right balance between the number of records you need to enumerate in your system.
2. Align your data architecture: Confirm the right relationships between your data elements and records by aligning them with your user cases and how your downstream business processes and systems need to consume the data.
3. Identify critical data elements: Determine and prioritize critical data elements to manage your data more successfully.
4. Build and use your golden record: Define your data collection methods, sources of truth, and business rules and build out your data collection strategy for each business use case.
5. Refresh and validate your data: Cleanse and validate the entire master data management system regularly to standardize, clean, de-dupe and augment provider information.

Creating a golden record for your data requires significant time, effort and resources. But once you build it and have a solid strategy to maintain it, your golden record will yield a long-term return on your investment and a distinct competitive advantage.

Contact LexisNexis® Risk Solutions to unlock the power of data, insights and analytics to power next-generation healthcare technologies and platforms to enhance clinical research efforts, bolster patient engagement programs and much more.

About LexisNexis Risk Solutions

The Healthcare Business of LexisNexis^® Risk Solutions harnesses the power of data, sophisticated analytics platforms and technology solutions to empower healthcare organizations with critical insights to transform operations and create healthier communities.

LexisNexis Risk Solutions is a sponsor of Healthcare Scene.