The Path to More Accurate Provider Data
How to Achieve a Golden Record with More Accurate Provider Data
Accurate provider data is foundational to the U.S. healthcare system. Collecting and maintaining this data, including providers’ names, practice addresses, office hours, specialties, sanctions, and hospital affiliations, is critical for timely patient access to care, automatic claim processing, network management, compliance, fraud detection, physician recruitment and more. But much of this provider data has a short shelf life. The Centers for Medicare and Medicaid Services reported that more than 45% of provider office locations listed in online directories contained at least one error.1 And although the industry spends more than $2.1 billion annually to maintain provider data, the system is still inefficient and error-prone.2 Without proactive management and the right technology, provider data quality degrades rapidly. This white paper explores the reasons for inaccurate provider data and how your organization can realize the real-world benefits of maintaining a more complete and more accurate provider data:
The roadblocks to accurate provider data
How difficult can it be to maintain accurate provider data? The question assumes that the data remains mostly unchanged and should be reasonably easy to maintain. However, reconciling, managing and maintaining accurate provider data can be a monumental undertaking. Let’s look at some of the hurdles organizations face in maintaining accurate and complete provider data.
Real-world benefits of mastering provider data management
Organizations that master provider data management benefit from a single source of data - a “golden record” - that has been integrated from various sources and applications into a more reliable and more accurate view of the provider. The result: better quality data that leads to better patient care and experiences, lower costs, and improved efficiency. For example one might list name, address, phone number, and email address while another lists name, address, date of birth, and social security number, the technology used to enable linking requires expertise and finesse. Technology also must support linking efforts across both identified and deidentified data needs; so, various technologies continue to evolve.
5 steps to create and maintain your golden record
Mastering provider data management isn’t an easy undertaking. Achieving a golden record requires a comprehensive approach to data management with systems for collecting, verifying and managing data from disparate sources. And because provider data changes so frequently, healthcare organizations must be vigilant in keeping the data up-to-date.
From chaos to competitive advantage: The story of a healthcare business creating a provider data “golden record”
Provider data can be one of your organization’s most powerful assets -if it is accurate, reliable and up-to-date. Creating a golden record for your data requires significant time, effort and resources. But once you build it and have a solid strategy to maintain it, your golden record will yield a long-term return on your investment and a distinct competitive advantage.
References
1 Online Provider Directory Review Report, Centers for Medicare and Medicaid Services, 28 Nov. 2018, https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/Provider_Directory_Review_Industry_Report_Round_3_11-28-2018.pdf.
2 “Defining the Provider Data Dilemma,” CAQH, 2016, https://www.caqh.org/sites/default/files/explorations/defining-provider-data-white-paper.pdf.
