Picking Up Where We Left Off in Improving Provider Data Management

By Jim Dougherty, Co-founder & Chief Executive Officer, Madaket Health
Twitter: @MadaketHealth

Suffice it to say: the healthcare industry has been laser-focused on the coronavirus pandemic for the past few months. With the urgent care needs that COVID-19 continues to bring and telehealth taking center stage in primary care, many other facets of healthcare — like provider data management — have become afterthoughts.

Before the virus hit, there were many initiatives, studies and reports highlighting the need for improved administrative functions, particularly surrounding provider data management.

As healthcare settles into a new routine, it’s time we pick up where we left off in tackling administrative waste.

The problem of provider data management
Inefficient processes and systems seem to be built into the DNA of healthcare. The ongoing debate about how to improve healthcare involves a multitude of opinions from patients, providers, payers and the public. While there may be general agreement about the need for improving healthcare, priorities and solutions are widely divergent. However, all stakeholders agree on one key issue: providers should spend more time with patients and less time on paperwork.

A significant but often overlooked driver of administrative burden is provider data management. Many functions of the healthcare business rely on accurate data, including health plan directories, provider-to-provider communication, credentialing, compliance, and payment for services. However, inefficient and complicated processes lead to poor payer-provider collaboration.

Even though provider data maintenance is critical for healthcare workstreams to run smoothly, inaccuracies are commonly found. A 2018 report from the Centers for Medicare and Medicaid Services (CMS) revealed that almost half of provider listings in Medicare Advantage (MA) online directories had at least one inaccuracy. Typical inaccuracies include providers not at the location listed, wrong phone numbers and incorrectly listing providers as accepting new patients.

All these small missteps add up to big mistakes. It’s not uncommon for a patient to find a physician in a health plan directory, visit the physician and receive care, only to later find out the provider is out-of-network. Mismanagement of provider data—often the result of repetitive, manual, error-prone processes—contributes heavily to claims processing errors, adding nearly $17 billion annually in unnecessary healthcare costs.

The effect of COVID-19 on provider data management
Under normal circumstances, these inefficiencies and inaccuracies create problems, so amid a public health emergency, these challenges are amplified. During the COVID-19 pandemic, all functions of the healthcare system are being tested and pushed to their limit. Usual administrative processes have fallen by the wayside; payer rules and requirements have changed; hard-hit hospitals have onboarded additional clinicians; short-staffed practices are left with more administrative burden.

Additionally, the temporary and permanent practice closings have made it nearly impossible for directories and other processes that rely on accurate provider data to be up to date.

Providers are rightly focused on patient care and keeping their practices open, not updating their demographic information.

Inevitably, provider data management is suffering during this time of heightened strain on the healthcare system. And COVID-19 has only reminded us to continue fighting the good fight against unnecessary provider administrative burden.

Pushing automation forward
Before the pandemic, automation was a viable solution that even CMS was touting to help solve administrative burden through its Patients over Paperwork initiative.

Especially during a period of increased care services, more instances of telehealth, and remote monitoring progress, it’s clear that the best solution for provider data management continues to be digitization and automation.

By creating a better process with a single source of truth, provider data management can transform burdensome processes into freed up time for patient care, both now in the pandemic and beyond.