Provider data management in the age of digital health transformation

by Howard Koenig...  

​Provider data management faces growing challenges in the age of digital transformation at a pace that may be difficult for organizations to match. Current data management processes and analytics capabilities may serve as a roadblock to its evolution.
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A 2016 McKinsey Survey points to data management as the primary challenge for organization, finding that “86 percent of executives say their organizations have been at best only somewhat effective at meeting the primary objective of their data and analytics programs, including more than one-quarter who say they’ve been ineffective.” *

If online search directories, referral sources, or other provider data solutions pull from insufficient provider data sources and inaccurate data, it can set off a chain reaction that impacts consumer and provider experience, as well as clinical and financial outcomes.

Inaccurate provider data along the utilization workflow can lead to:

• Gaps in care (from network leakage and care delays)
• Negative consumer experiences
• Negative provider experiences
• Costly regulatory fines
• Overpayments

The inability to access comprehensive, accurate provider data creates gaps in care and negatively impacts overall satisfaction, health outcomes, and the bottom line due to fines, overpayments, and loss of members and providers.
When network leakage (meaning a patient/member is treated at an out-of-network provider) occurs, critical patient data, such as lab testing, physician notes, and diagnostic imaging studies may be missing from the overall health record, creating a potential gap in care.

Accurate provider data can also lessen delays in care which occur when a member/patient selects a provider who is no longer in business, has moved to a different location, or is no longer in the health plan’s network.

A well-managed, authoritative provider data enterprise helps to prevent leakage and care delays that can lead to gaps in care due to missing patient/consumer information or inaccurate provider information. This includes both provider search directories and referrals management solutions which enable providers, care managers, and other stakeholders to identify the best in-network provider to whom to refer a patient/member.

*  https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/the-need-to-lead-in-data-and-analytics