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Expand the Data Quality Conversation to Include Provider Data

By Thomas White | August 18, 2017

A hot topic among healthcare payer and provider executives these days — and deservedly so — is the need to improve the quality of the information the healthcare industry uses to transact payment and improve the quality of clinical care. However, much of the conversation has traditionally focused on payer data (to ensure maximum and timely payments) and patient data (to track treatment plans and progress).

The benefits of running a healthcare organization with higher quality provider data needs to be part of this conversation as well. Quality provider data contributes to the timely delivery of cost-effective, quality healthcare as much as quality patient and payer data.

The conversation is never more relevant. Over the past decade, federal and state policies have initiated a “volume to value” shift, forcing healthcare systems and their providers to transition from a fee-for-service (FFS) model to value-based care. In this new environment, the need is even greater for accurate provider data.

This premise is supported by a white paper published in 2016 by the Council for Affordable Quality Healthcare (CAQH). They found that a lack of quality provider data negatively impacts delivery of quality care in many ways.* Take these scenarios, for example:

  • Referrals — Providers and consumers trying to locate specialists or other providers can’t do so if provider contact information is inaccurate.

  • Provider Directory — Consumers can’t successfully access network providers if provider directories are not up-to-date. Health plans may be vulnerable for the costs of out-of-network care and subject to penalties if consumers or referring providers chose incorrectly based on inaccurate provider listings.

  • Information Exchange — Efforts to exchange clinical data among care team members can be thwarted by inaccurate electronic addresses. When provider data is inaccurate, time and other scarce resources are often wasted to resolve the discrepancies and can leave providers open to fraud, waste and abuse.

On the other hand, if the provider data is high quality (current, complete, accurate, auditable, etc.) and easily accessible to those who need it when they need it, everyone benefits. According to the CAQH’s paper, to ensure higher quality data, all stakeholders who produce or provide that data must contribute to its maintenance. The contributions must be from individuals as well as technology.

Phynd offers healthcare systems an Provider Information management (PIM) solution of SaaS applications and professional services that securely gathers, manages and shares high quality provider information to improve clinical communications, revenue cycle, provider search, and risk management.

* Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration, Council for Affordable Quality Healthcare, 2016.

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