An Opportunity for Transformation

While the advancement of technology and development of a larger healthcare system have helped people obtain better health outcomes, they’ve also created a more complicated process for everyone involved in the process. Scott Vasey believes that many of these challenges center around the accuracy and accessibility of data.

“As we look at coordinating systems of care, it’s really about a data-driven approach to the people, processes and technology that are involved,” he explained. “That’s the complexity of healthcare. You get the claims-based data, but you also get the EMR-based data.” This data can be extremely useful, but only when it’s accurate and able to be accessed by payers and providers in real time.

On the payer side, “85% of all healthcare dollars under medical cost goes back to paying a provider. And if you can’t pay that provider correctly because you don’t have the correct address, or you don’t have the correct tax ID, or you don’t have the correct electronic funds transfer requests, then that’s just the start of it,” Vasey explained.

Meanwhile, providers also struggle to input patient data in real time, because they lack a single portal where they can easily add information at the point of care.

Improving Accuracy Across the Workflow

To address these issues, AmeriHealth Caritas set out to create a platform that would house the entire process of provider network management from onboarding new providers to credentialing and contracting to make it easier for providers to engage with AmeriHealth and input and access data.

“We had a lot of boxed solutions, but none that actually created an entire workflow that allowed us to bring in data about a provider, enroll them in the plan, credential them, contact them, produce directories, pay claims, and ultimately service that provider in a way that brought the data back to them and was consistent and usable throughout the organization,” Vasey explained.

By working with Virsys12 and using their V12 Network application, Vasey and his team have been able to start developing this type of system and envisioning a new future for the industry. “The art of the possible is now visible to [my team],” he shared.

Why Provider Experience Matters

In his own work and across the industry, Vasey believes a shift is taking place, where healthcare professionals are starting to focus more on improving the provider experience. For Vasey, this is the “fourth leg of the stool” when it comes to industry transformation — along with improving patient care, improving cost of care and improving patient experience. An optimized provider experience will not only help prevent provider burnout that leads to staffing shortages, but it will also improve every other area of the industry, Vasey argued. Also, new government regulations make it imperative we produce accurate provider directories for our members.

“It improves the quality of care that’s received, it reduces the total cost of care for that member over their lifespan, and improves that member’s experience over their lifetime so they’re achieving their own individual goals.”

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