Solving the Healthcare Provider Directory Challenge

$2.76 billion annually. Nearly a thousand dollars a month (per provider). That’s how much provider directory maintenance is now costing physician practices nationwide, according to a new survey by the Council for Affordable Quality Healthcare (CAQH). As practices work with more providers and contracts, that tab only gets higher.

On the other side of the equation is the cost for health plans. The administrative costs are significant, the financial risk are high and the problem is impossible to solve without great technology to handle the massive amounts of workflow and data updates required to accurately maintain the provider directory for both provider practices and health plans.

In healthcare, managing provider directories has become such a time-consuming, administrative burden that it’s costing practices the equivalent of one staff day per week, according to CAQH’s analysis. What’s worse, the dollars and cents are only part of the challenge.

While practices struggle to keep directories up-to-date, the additional costs of inaccurate information can quickly add up, from patients inadvertently choosing out-of-network doctors or not knowing a practice has moved to poor network performance and a lack of good data to make strategic decisions. If the directory isn’t accurate, it can also interfere with care coordination and the ability to share clinical information. Provider directories that are plagued by errors and inaccuracies can even be subject to CMS fines.

Of course, there’s a reason it’s so expensive and cumbersome to maintain accurate provider directories. With the traditional tools and myriad systems practices and health plans have had to work with, it hasn’t been easy.

What is provider data management in healthcare?

As CAQH explains, “Provider data drives the most fundamental processes in the healthcare system. The industry relies on it to connect patients with healthcare professionals, license providers, exchange information and pay for services. Inaccurate provider data puts patient care and billions of dollars at risk.”

In this ever-evolving healthcare environment, having that foundation and being able to manage and continually update that data in an efficient way is essential, but it’s easier said than done. With constant changes, inconsistent (and sometimes incompatible) systems, manual processes and scalability issues, it’s been exceedingly difficult for healthcare organizations to get their arms around it. The result is that they often end up with a system that’s prone to errors and demands more and more internal resources and time devoted to it.

Many healthcare organizations are taking on an additional burden by designing and building their own provider directories from scratch. This can require a huge investment of time, resources and high-level technology expertise to integrate multiple data sources, test, update and maintain over time. With so many external variables and ongoing shifts within health organizations and at the policy level, the effectiveness of these systems depends on having a full team in place to continually monitor, adjust and implement improvements.

Improving provider directory management

Despite all of these challenges, providers recognize how important it is to maintain accurate directories, and they’re searching for better answers.

Citing the AMA’s 2018 findings, which showed that 67% of physicians expressed an interest in having their practice use just one interface to send and update information about their providers to payers, CAQH has outlined a way forward. The organization argues that a single platform across all lines of business—in which practices can enter, update and review their practice information and then share it with multiple plans at once—is a promising solution to this ongoing challenge.

In fact, based on their analysis, streamlining directory maintenance this way could save physician practices nationwide at least $1.1 billion annually. Their conclusion: “A single broadly adopted platform and a shared commitment by both plans and practices can enable meaningful progress on the provider directory dilemma.”

What to look for in a provider directory platform

 What should that single broadly adopted platform encompass? Some of the must-haves, like OIG compliance and HIPAA compliant CMS and payer reporting, are fairly self-evident. Here are a few of the other components to look for to make sure you’re getting the level of efficiency and effectiveness you need from this essential system:

  • A 360-degree view of your relationships: There are a host of complex many-to-many relationships involved in provider network management. Your platform should give you the visibility and insight to manage all of them, including provider and ancillary groups, employer and payer relationships, member services, and member and physician communications.
  • Streamlined administrative processes and automated workflow: Even in today’s digital era, paper-driven onboarding still happens, creating huge barriers to efficiency and accuracy. To streamline your back-end processes and make it possible to support thousands of providers and hundreds of thousands of patients, look for a solution that includes robust integration capabilities, workflow tools, automation, analytics and reporting all in one platform.
  • Provider credentialing, relationship tracking and outreach built in: Having the credentialing and communication infrastructures built into the platform will make it much easier to manage provider relationships, outreach and education and keep your provider directory up to date. CAQH found that using a single platform to exchange credentialing information resulted in 39.6% lower associated administrative costs compared to those who used multiple approaches.
  • A “single source of truth” and intelligent processes to enhance data integrity: One of the most valuable aspects of an effective provider management directory is that it serves as the centralized hub for provider contacts, practice staff and organizational structures. This helps you ensure everyone is working with the most up-to-date information, and it also helps facilitate open collaboration across the organization. A system that is comparing profile profile information from various system (claims, CMS, provider scorecards, credentialing, OIG status data, etc) can proactively fill in the gaps when new information about a provider is surfaced. For example, the provider can be updated automatically when a provider is found to be practicing at a new location or with a new specialty, or has a new state license number, or appears on an OIG exclusion list.
  • Pre-mapped, pre-tested processes and software: You shouldn’t have to waste time and money by trying to reconfigure and piece together disconnected systems and software. A flexible, scalable platform that’s already been tested in the marketplace will get you up and running quickly and at a much lower cost. This will also cut down on the need for manual processes and lower your overall administrative costs.

Making the move to a single platform is one of the best things you can do to improve your efficiencies, reduce administrative costs and decrease the frustrations involved with provider directory maintenance. The good news is, you don’t have to build it from scratch. In fact, you’ll get a better ROI and expedite your time to market by going with a proven, customizable solution that allows you to scale to new markets and add new networks with confidence.

Build and maintain your provider directory and network with V12 Network and V12 Provider Data Engine (V12 PDE) . Find out how.

About the Author

About the Author

Tammy Hawes is CEO and Founder of Virsys12, a Healthcare Focused Salesforce AppExchange and Consulting Partner. Hawes launched Virsys12 in 2011, with a track record of more than 25 years of executive success.

About the Author