What Does “Quality” Actually Mean?
“We have quality provider data.” It’s a phrase often heard in boardrooms and strategy meetings, yet it rarely holds up under scrutiny. The myth of quality provider data stems from a narrow definition of what “quality” actually means.
Most healthcare organizations measure provider data quality by its accuracy at a given point in time. But in the real world, provider data is fluid and changes daily. Clinicians change practice locations, acquire new specialties or licenses, accept or drop networks, take leaves of absence, or lose licenses. Static data, no matter how accurate at capture, quickly becomes outdated.
The Need for Real-Time Data Management
True provider data quality involves more than a one-time verification at credentialing or re-credentialing. It is no longer good enough to review provider data at a given point in time. It requires real-time daily updates, multi-source validation, and continuous monitoring. Quality also means accessibility; data must be readily available and actionable within the workflows that rely on it.
Unfortunately, many Health Plan Payers and Health Systems, Integrated Provider Network, Managed Care Organizations, Benefit Managers, Specialty Networks, and Third-Party Administrators still operate under outdated assumptions. They maintain sprawling spreadsheets or disconnected databases and conduct periodic clean-up efforts. These approaches create lag time between when a change occurs and when it is reflected across systems.
Redefining Quality for Today’s Healthcare
To overcome the provider data challenge, these healthcare organizations need to redefine quality. It should be synonymous with timeliness, completeness, and contextual relevance. Provider data must be integrated into operational workflow systems for provider onboarding, credentialing, contracting, provider directory and claims payment that automatically update and distribute changes across the network.
Organizations must also embrace the idea that quality provider data is a continuous process, not a static achievement. Only by acknowledging this reality can they begin to leverage data as a true strategic asset of provider data and provider networks.
Break Free from the Data Myth
Think your provider data is up to standard? Let us show you what real quality looks like. Contact Virsys12 to schedule a demo and see how our solutions keep provider data accurate and up-to-date in real-time and automate processes to capitalize on the value of provider networks.
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