In the rapidly evolving healthcare industry, the need for seamless provider data management and contracting processes has never been more critical. Healthcare organizations face significant challenges in managing provider data and contracts across multiple systems, leading to inefficiencies and lost opportunities to improve care delivery.
In this Q&A, Tammy Hawes, Founder and CEO of Virsys12, and Tom Cowen, Head of Vertical Strategy – Healthcare & Life Sciences at Conga, share their insights on the unique challenges healthcare organizations face with fragmented systems, the benefits of a unified approach, and how their collaboration is transforming the healthcare contracting landscape.
What challenges do healthcare organizations typically face with separate provider data management and contracting solutions?
- Tammy Hawes: Keeping data in sync across multiple systems is notoriously challenging, leading to frequent errors. We also see that the contracting terms and fee schedules often appear in the contracting system as unstructured data, making them difficult to utilize, search, or analyze at an enterprise level.
- Tom Cowen: The main challenges that we hear of are slow, inaccurate systems that don’t provide visibility into the enormous contract volume.
What are the key benefits of integrating provider data management with contracting processes?
- Tammy Hawes: When the contracting and credentialing teams can share real-time data, it’s easier to keep information up to date, which reduces manual corrections and enhances efficiency.
- Tom Cowen: I’ll focus on one key aspect here and that is velocity. The provider lifecycle and the contracting lifecycle within it rely on numerous pass-offs between stakeholders in the process. The better these can be managed within a single or fewer systems the faster and more accurate the process gets, and the more satisfied providers are too.
How does a unified approach to provider data management and contracting impact the relationships with healthcare providers?
- Tammy Hawes: A unified approach to provider data management and contracting allows provider relationship agents to quickly access contracted rates, which helps them answer provider inquiries more effectively and strengthens the provider relationship.
- Tom Cowen: Understanding your provider network’s preferences and behaviors is essential. For example, one of our pharma clients transitioned from a case-by-case view to a more comprehensive patient-centric model, shifting how they manage data on Salesforce’s Health Cloud. This level of data structure and access makes a significant difference in supporting providers and ultimately benefits patients as well.
What trends in healthcare are driving the need for more integrated solutions like the one Virsys12 and Conga offer?
- Tammy Hawes: For healthcare organizations to fully benefit from some of the advancements in AI for admin processes and systems, the provider data needs to be accurate and available in a structured format. Contract data has historically been unstructured, missing out on potential efficiencies. If administrative costs could drop from 25% to 5%, we could reallocate those funds to patient care.
- Tom Cowen: We see three major trends driving the need for integrated solutions like the Virsys12 and Conga partnership deliver on:
- Value-Based Care: Success in value-based contracting depends on clear metrics, transparency, and streamlined dispute resolution—requirements that integrated systems can better support.
- Provider Tumult: Whether it be the struggles of small, rural hospitals as a result of Covid or the merger activity of the larger players, the Provider space is undergoing a profound change. Each change in a brick-and-mortar hospital’s ownership structure requires a re-evaluation of account hierarchies, fee and value-based contracts and amendments, renewals and terminations. Overall, it is best handled by highly integrated systems that have strong functional capabilities.
- Remote Medicine: From consumer devices that monitor anything from blood sugars to heart rate to sleep, the landscape of AI and data are driving immense change. Add in the explosion of telehealth as a result of Covid-19 and many questions need to be answered around where care is delivered and how it is paid for.
How can collaboration between companies like Virsys12 and Conga help healthcare organizations achieve better outcomes?
- Tammy Hawes: Partnerships like the one between Virsys12 and Conga combine best-of-breed together to give customer the benefit of point solutions in an enterprise shared environment.
- Tom Cowen: Beyond efficiency, these collaborations reduce manual touchpoints—like in fee-based contracts, where each human intervention is an opportunity for error. Fewer touchpoints mean faster processes and better data accuracy. Integrated systems also allow agile adjustments in value-based contracting, vital when contract terms require frequent recalibration to remain mutually beneficial.
What future trends do you foresee in the contracting landscapes, and how can organizations prepare for them?
- Tammy Hawes: A growing trend among large health systems and payer organizations is to centralize provider contract data within a provider lifecycle management system like V12 Network. This allows for real-time reporting and easy querying, enabling organizations to quickly answer provider questions, assist members in finding providers that fit their location, network, and budget needs, and keep provider demographic information updated in real time—often by allowing providers to manage their own data directly.
- Tom Cowen: AI is by far the number one change agent in the contracting landscape, offering unprecedented capabilities for analyzing legacy and third-party contracts. With AI, users can quickly gain insights into contract intent and terms, which is especially impactful during mergers, where immediate understanding of an acquired company’s contracts can significantly influence merger success. One of our customers, for instance, has over a million legacy provider contracts—an unmanageable volume without AI. What excites me most in the healthcare and life sciences (HLS) contracting space is Conga’s capability to interpret contract tables. Beyond reading clauses, Conga’s AI can analyze the detailed data typically found in tables, such as pricing, rebates, fees, value programs, and membership information—critical elements that elevate contract intelligence to the next level.
