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Why Provider Information Management is Crucial to the Success of the Clinically Integrated Network

By Thomas White | May 3, 2017

The evolution of hospitals into healthcare systems and now increasingly into clinically integrated networks (CINs) intensifies the challenge of managing an expanding patchwork of providers – physicians (both credentialed and referring), APRNs, and other licensed healthcare professionals. This challenge is exacerbated by the fact there are not only more providers within a CIN, but also more of them working in a wider variety of care settings. A promising solution to this problem is provider information management.

Driven by value-based care objectives, CINs are focused on increasing quality of care and patient safety, maintaining margins by reducing costs and waste, and increasing revenue by keeping patients within their physician network. Accomplishing these goals demands a secure and enterprise-wide provider information management approach to gather, manage, and share provider information within the CIN to accommodate the dynamic nature of these referral networks.

Quality provider information is also vital for provider search tools that drive the referral management program so important to a CIN. Potential patients who visit a hospital website to search for a local in-network doctor or specialist expect the provider information they see to be accurate, complete, and current. Moreover, physicians themselves expect the same quality information when using these search tools to refer their patients to specialists.

The range of essential provider information to be managed exceeds simple contact information and insurance plan participation. It must include physician communication preferences, affiliations, licensing data, practice location, internal system IDs, exclusionary lists, and other sensitive information. And in today’s consumer-driven economy, patients demand even more information, such as the provider’s picture, business hours, multiple travel directions (e.g., by car, mass transit, walking), and publications, etc. While some static provider data rarely changes, other data is more dynamic and changes more frequently. In fact, a recent Wall Street Journal article revealed that 2.4% of all providers change addresses or other contact information every month, and 30% change their hospital or practice-group affiliations every year.*

Everyone assumes the provider information they rely on is accurate. But when it turns out not to be, costs rise, revenue opportunities are missed, exposure to compliance risks increases, and patient satisfaction erodes.

Collaborating over large referral populations and controlling value-based payments are mission critical for CIN success. The quality provider information needed by clinical and operational systems to achieve these goals can only be managed with a provider information management solution.

* Beck, Melinda. " Health Insurers to Face Fines for Not Correcting Doctor Directories." The Wall Street Journal 28 Dec. 2015.

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