A Three-Pronged Approach to Improve Provider Network Adequacy: Part 2

Part Two: How to get Accurate, Accessible and Affordable Provider Data

Recently, we threw a spotlight on the futility of calling and faxing providers to obtain and verify information. Today, we’re diving into the smarter alternative.

To refresh your memory, the standard practice of calling and faxing provider offices has led to disastrous results. Despite an investment of $2.1 to $2.3 billion per year, the 2020 provider directory review by Centers for Medicare and Medicaid Services (CMS) revealed:

• 50% of provider directory listings had a least one error.

• Accuracy declined from 48.39% to 44.79% between 2018 and 2020.
• Errors still center around the most basic information including whether providers work at a listed location and if they are accepting new patients.

Everyone knows that calling and faxing doesn’t work. What everyone doesn’t understand is what to do instead.

Leverage existing and trusted relationships to obtain data without spending a fortune

Innovative healthcare data experts ask the questions – where is each piece of data created? How can we remove the element of contextual misunderstanding? How can we make this process easier for everyone and better all around?

Provider data is not limited to the attributes of the individual doctor or service location, but includes contract-level terms that are much more difficult to gather and ratify. Much of the contract level data is controlled through management companies that deliver administrative services to the provider community.

Providers make conscientious decisions around the people and organizations they trust in the exchange and execution of sensitive and important information to keep their medical practices functioning.

For example, Dr. Patel is part of an Independent Physician’s Association (IPA). The IPA helps Dr. Patel submit claims and get paid – they enjoy a trusted relationship with one another. To ensure appropriate payment, the IPA needs Dr. Patel’s contract-level details (i.e. primary phone number, billing address, service locations, accepted plans and products, etc.).

Similarly, when someone from the IPA reaches out to Dr. Patel, it isn’t a bother, the response isn’t relegated to whoever is handy. Dr. Patel and staff are motivated to ensure the IPA gets the information it needs.

Would you rather?

From a data collection perspective, it’s a no-brainer. Would you rather A: Get everyone’s data from a few primary sources and know that it’s accurate? Or B: Continue to chase down each and every provider to get the same inaccurate results?

Further, accurate provider data is important to these primary sources. When data conflicts arise, they are quick to investigate and resolve. Because provider data is their primary, daily business, they want to get it right and keep it right. In this way, we remove the burden of verifying provider data from provider and payer alike.

Single source of truth

Industry experts confirm what everyone knows. The creation of a true single source of truth would save billions of dollars each year. Health plans could save 75 percent of the annual $2.1 to $2.3 billion spent maintaining provider databases.

It’s a daunting endeavor to create a single source of healthcare data that works for everyone. As the experts behind some of the country’s largest and most reliable healthcare data platforms, we can attest to the enormity of the task. It’s not impossible, however, with the right data model and the right data experts at your side.

Stay tuned. Next, we discuss how to make a single source of healthcare data work for everyone. Yes, everyone.