Guest: Alex Ding, MD, MBA, Chief Medical and Public Affairs Officer, DataSpring
LinkedIn: Alexander Ding, MD, MBA
LinkedIn: DataSpring
When provider data is accurate and connected, patients can find the right care more easily. As a practicing radiologist, I have seen how fragmented information can delay access, complicate care and create avoidable friction for patients and clinicians.
Many of us have experienced this problem personally. We have searched for in-network care, encountered unexpected costs or helped loved ones navigate the healthcare system. Patients should be able to identify an appropriate clinician confidently, understand their coverage and make informed decisions about where and how to receive care.
Accurate, current provider directories are foundational to that experience. Yet maintaining them can be difficult for practice groups, hospitals, health systems and health plans managing information from many sources.
In my recent conversation with Beth Friedman, FACHDM, senior partner at FINN Partners, on the FINN Voices podcast, we examined these challenges and the opportunities to improve provider-data accuracy. We also discussed practical steps health systems, payers and administrators can take to streamline verification, reduce errors and improve access.
What Is Provider Directory Data and Why Does It Matter?
A provider directory brings together key professional, practice and network information about clinicians and their practice locations. This may include:
- Education
- Credentials and certifications
- Provider-reported demographic information
- Specialties
- Practice locations
- Health plan participation
- Whether the provider is accepting new patients
- Telehealth availability
- Phone and fax numbers
Patients and their families rely on this information to answer important questions: Is this clinician in my health plan’s network? Are they accepting new patients? Is the location convenient? Do they offer the specialty, language or virtual-care option I need?
When this information is accurate and current, patients can navigate care with greater confidence. Reliable directories also help reduce so-called ghost networks, in which listed providers may be outdated, nonparticipating or unreachable.
Accurate provider data is therefore more than an administrative requirement. It is an important foundation for timely patient engagement, informed decision-making and better access to care.
How to Reduce Administrative Burden and Improve Data Accuracy
Hospitals, health systems and payers collect provider information from multiple sources. Without coordinated standards and processes, those records can become duplicated, incomplete or inconsistent.
Organizations often address these gaps through manual roster reviews and verification calls. According to DataSpring research, one-quarter of surveyed practices receive 15 or more verification calls each month, and 40% of calls last more than 15 minutes on average. Verification is essential, but repetitive outreach creates an opportunity to streamline workflows and return valuable time to practice staff.
The future is a provider-data ecosystem in which information is verified efficiently, updated consistently and exchanged securely across participating organizations. Patients will identify the right clinician with greater confidence, while practice staff spend less time responding to repetitive requests. Health plans and health systems will also have more reliable information to support their operations.
Reaching that future requires shared data standards, interoperable technologies, including FHIR-based APIs, and ongoing verification. Together, these capabilities can support a more reliable, consistently maintained source of provider information.
Accurate provider data is foundational to patient access. When providers, health systems, payers and data partners work from reliable, current information, patients connect with the right clinician, in the right setting and within the right network. This means less friction for everyone involved.
Listen to the Conversation
About FINN Voices Podcast
Amplifying the power of health innovation to improve people’s lives.
FINN Voices amplifies the power of health innovation and information technology. Hosted by health experts from FINN Partners, each episode offers a peek behind the curtain of innovation with healthcare’s leading changemakers. We talk about their ideas and challenges along the way; continually shaping critical conversations and introducing the new health technologies that lie ahead.
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