Top 3 Provider Data Management Issues Impacting Health Plans
Wednesday, October 28th 2020
Provider Data Management (PDM) has been a fragmented and costly undertaking that continues to frustrate health plans throughout the country and across all lines of business. Among others, there are three main issues facing these organizations.
1. High Cost of Inaccurate Provider Data
Inaccurate provider data is costing health plans more than they realize. Payers are losing millions in unnecessary print and postage costs communicating with their network providers due to multiple duplicate records and other basic data flaws. Inaccurate provider directories continue to draw significant member complaints. Claims admin costs are unnecessarily high, quality and risk analytics processes are plagued with errors resulting in duplicate and unnecessary medical record retrievals, some payers have formed internal teams to manually and painstakingly curate their own provider data at significant expense, yet CMS' own provider directory data audit reports still reveal nearly 50% inaccuracy1.
2. Complexity of Provider Affiliations
The average practitioner is affiliated with at least 4 and often as many as 7 or 8 different IPAs, PHOs, partnerships, and other provider entities. The burden that these complex and ever-changing affiliations create for payer systems and operations is unyielding.
Add to this complexity the fact that 57% of the 6.2 million NPI records in the NPPES database have not been updated in over 5 years, with more than half that number not being updated in over 10 years2.
3. Vendor Creep
Health plan executives conduct periodic reviews (and often lament) their ever-expanding list of service and technology vendors along with the mounting administrative expense. The very fragmented PDM space has many payers contracting with 3 to 5 vendors for different technology or services dealing with their provider data, and most often still do not have a centralized Master Provider Index to supply accurate provider data to each of the internal IT systems (i.e., prior authorization, contracting, credentialing, claims, care management, risk and quality analytics, etc.). This 'vendor creep' is also very costly.
Many PDM technology vendors continue to place much of the burden for data accuracy on healthcare providers themselves, which has resulted in high data error rates, unnecessary costs, lost revenue, and heavy administrative burden.
The Curatus (formerly known as Animas Data Solutions) technology addresses each of these PDM challenges. Our ProviderLenzSM platform continuously disseminates accurate provider information via API to ALL payer operational systems, acting as the 'source of truth' for the entire organization. A proprietary data accuracy grading algorithm assigns an 'Accuracy Confidence Level' score to each provider record and to the entire provider network, giving health plan leaders a simple and clear picture of the accuracy, completeness, and reliability of their provider data at all times.
ProviderLenz also features automated handling of key compliance requirements, including quarterly data attestation outreach to contracted providers, continuous network adequacy monitoring and alerts, Provider Preclusion administration, IRS Form W-9 administration, sanctions monitoring, and more.
All this is achieved with a single vendor and with no changes to a payer's current IT infrastructure, enabling Curatus to provide minimum savings guarantees over a health plan's current spend along with guaranteed data accuracy levels.
Learn more: https://curatus.com/providerlenz/
1 CMS Online Provider Directory Review Report (Jan2018)
2 NPI Aging analysis completed by Animas Data Solutions, LLC in October 2020