Navigating the Complexities of Roster File Management

by Mark Mozley

For those of you who know me, you’ll know I’m a lover of idioms, colloquial expressions, and anecdotes.  It’s second nature in my role as Head of Sales & Marketing. Language is colorful, and especially for my profession, its variety is a great enabler for engagement, persuasion and education.
 
Variety, however, is not an enabler when it comes to categorizing data, especially with large datasets, that change frequently. 

Take health plans, third-party healthcare administrators, and workers’ compensation programs, for example.  They’re still struggling with foundational components of the provider networks they manage.  An example? The infamous roster files. ​

If you’re not familiar, a roster file is a list of healthcare providers with various pieces of meta data (such as service locations, specialties, etc.).  These files help track which providers are part of an insurance network, feeding into the company’s provider directory.
 
Despite ongoing efforts to standardize, each network of healthcare providers has their own format in terms of content - both in terms of fields and ontologies- and file type.  Each network sends their file to the various health plans they’re contracted with. And, for health plans, this often means they’re dealing with thousands of files per month, all with varying levels of change. 
 
The onus is on the health plans to organize this chaos into a single source of truth.
 
Accuracy is everything – not just because the government requires it (though that’s a big part), but because it’s critical for making sure claimants in workers’ compensation get the right care, and health plan members find the right in-network doctors.  And of course, accurate data also ensures claims are processed correctly, which keeps the wheels turning smoothly.
 
There are complexities with the ways to normalize these roster files, and how you can clean, enrich and validate so that a member or claimant has the care journey they need.
 
As for how folks generally solve for these issues, that’s no big mystery. It usually comes down to two options: build or buy.
 
I can practically hear you now - “No sh*t Mark.”
 
Typically, I see homegrown capability can take a few forms.

• Manual curation – This onerous task involves constant effort to keep information clean and up to date. Early on, when roster management procedures were simpler, this was likely a best-fit at the time. But today, with volume and velocity increasing, a labor-intensive process is fraught with a high risk of errors and costly mistakes.  These mistakes create critical vulnerabilities that can lead to severe downstream consequences, including compliance issues and inefficiencies that undermine value-based care initiatives. Additionally, the ongoing strain on the teams handling this vital task prevents them from focusing on more strategic and impactful roles, amplifying the overall pain and inefficiencies.
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• Internally developed tools – Programmatically, it’s not too hard to build a custom tool for extraction, transformation and loading (ETL) into dependent systems.  And when you compare this to the manual process above, it certainly offers more scale. But, and you knew there’d be one, the fragility of this approach can be exposed when networks change their roster formats (typically without notice), new networks are contracted with, there’s a requirement to enrich the fields or fill in the gaps, or the individual who built the tool moves on.  In addition, priorities of the day-to-day operations mean that continuing product innovation or exploration isn’t practical or simply doesn’t happen, creating additional technical debt over time.
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Last month, TalisPoint and Perspecta celebrated the 1st anniversary of the merger. Through this merger, there has been a lightening pace of innovation through combining the best of both companies, not just on roster management, but on all phases of provider data management. 
 
Regardless of your current approach, if you’re looking for a sounding board for how things can be done, please reach out, we’d welcome a discussion.

​Learn more about Perspecta's Roster Management solution

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