By Philip Gillich | Tags: Provider Data Management
While payers get much of the credit – good and bad – group practices handle behind-the-scenes struggles
The problems insurance companies face with provider directories are well documented; but equal, if not greater, challenges exist for health systems – and many of these issues have persisted unchecked for years.
Too often, provider updates are still trapped in the era of paper, faxes, and spreadsheets – and time-crunched providers and admins have too many other priorities to manage. But this data – about everything from office locations to languages spoken – is crucial to system revenue cycles, patient acquisition and experience, and much more.
System administrators can also be less than sympathetic when allocating resources to this important task. Provider relations specialists and data managers may have a hard time making a case for added tools or resources in the face of seemingly more pressing goals; in fact, they may be asked to do more with less.
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Let’s look at some of the other hidden challenges medical groups and family practices may face when it comes to capturing, maintaining, and sharing provider data.
The demand for fresh data is unrelenting
Providers are expected to refresh their information monthly for most or all of the health plans they work with – which means that the updating cycle is essentially endless. As soon as one deadline passes, the next one is already looming.
Custom formats are the law of the land
Health plans typically have their own unique formats for data updates, with little consistency or coordination. This puts the burden on group practices and providers to deliver updates in the arrangements and data formats that each insurer insists on.
Data updates take time from other crucial tasks
Despite the importance of keeping provider data current, it usually distracts from other jobs. Few of those dealing with this data have the luxury of focusing on it exclusively; provider data management is often the 10th or 11th task on a busy to-do list.
Payers usually have the last word
When it comes to winning more time or other concessions for updates, medical groups and family practices often feel they have little leverage. Insurance companies are their most important source of revenue, so the wishes of overworked providers and their administrators may hold little sway.
The good news is that solutions are available today – and they can make a huge difference to overworked health system administrators. Atlas’s Provider-Payer Connect is helping to break down the data barriers between providers and health plans, while making data updates nearly effortless. And technologies like AI have the potential to compress data analysis tasks to mere seconds, making provider data more accessible and useful.
As information and database solutions become more sophisticated – and commonplace – opportunities to escape from the dark ages of copy-and-pasting will multiply. But it will still take proactive work and vision to make change happen – a challenge health systems need to embrace as soon as possible!
Philip Gillich is Advisor to Atlas PRIME® and brings nearly 30 years of experience in the healthcare sector, with a special focus on provider relations and data.
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