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Value-Based Care Drives Demand for Provider Information Management Tools

By Special Guest
Tom White, CEO, Phynd
November 30, 2018

Healthcare consumerism and the shift to value-based care – including an explosion in the number and forms of clinical networks – are driving demand for provider information management tools in healthcare. As the sheer volume of healthcare networks continue to expand and evolve, this need will only increase.   

Now is a critical moment because healthcare networks depend on a robust and accurate provider data model to operate smoothly. Provider data needed includes where they practice, their clinical focus, their office locations, and how they get paid, including tiering and while adhering to Stark laws. Despite its central importance, provider data management has been overlooked to the point that most networks are managed in simple Excel files. The growth of value-based care has driven a growing realization among healthcare leaders: disconnects in their provider data can sink their networks’ clinical effectiveness and financial projections.

A new era: provider data takes the stage next to patient data
Healthcare networks have invested tens or hundreds of millions (and in the case of some health systems, billions) of dollars to have strong patient data management infrastructure for their patients’ journeys. Epic, Cerner and others reliably deliver EHR applications to help manage a patient’s care journey. These systems have a robust patient data management model which supports patient enrollment, management, search (both for the patient and for patient history, records or test results) and reporting.

Provider data management, however, remains hospitals’ and health systems’ Achilles heel. Why? In addition to the business need becoming paramount, no robust enterprise operational data management system has ever existed for managing providers.

Hospitals which have tried to repurpose their EHR for provider data management immediately ran up against structural limitations. EHRs lack a deep provider data model and any ability to enroll, manage, search for, and report on providers operationally throughout their real-time systems. Provider data management has emerged as perhaps the single largest area of need for health networks.

This is not a new problem; it was created by the way healthcare IT grew up as an industry. Information technology systems were initially developed to solve a single departmental management challenge in a hospital. The result was a system of silos, in which each hospital has a separate radiology information system, lab information system, an ER system, cardiology system, and so on – every department has historically had its very own IT system. Think of the lost efficiencies in such systems.

What’s worse, each of these operational departments maintains its own silos of data. The radiology IT team, for example, might have an impressive store of FAX numbers, while the marketing team owns a robust list of network providers that they post to the website. For each of these data silos, the department would have its own separate Excel spreadsheet – disconnected and managed independent of each other. The healthcare industry has been awaiting an industry-wide initiative to take those data silos and consolidate them across the entire enterprise. In the modern EHR world, a small group of vendors have built best-in-class departmental systems based on a single patient data model.

The Rise of Consumerism: New Challenges
Now health care leaders must learn how to compete in a new era of consumerism. For general search needs, patients know they can go to Google – the perfect natural language search tool – and get straight-forward information. Run search commands through a hospital's website, however, and it’s a different experience. You want to type in, “I’m a 65-year-old male with pain in my left foot, needing care in Charlotte that has Blue Cross Blue Shield” – but you can't do that. Instead, you check a box requesting to see a specialist – and you list the type of insurance you carry. We still cannot search health care information with the same ease as when we’re searching the Internet for products, stores, restaurants, or movie times.

Health systems must provide that ease of search. When consumers go to a health system website, they should be able to type in their age, gender, insurance, and symptoms – and get the right doctor who has an open appointment that’s convenient and easy to schedule. Healthcare search must provide an inventory management focus that reflects today’s consumer environment and mindset. Hospitals need a data model that gives consumers search tools to pinpoint the provider they should be seeing based on their symptoms, their location, and the type of care they need.

Deploying the right provider platform to manage your provider network
To combat these risks, health systems should deploy a provider information management platform with capabilities that include:

  • Single provider profile with all operational data on the providers to manage network participation, plan participation, hospital affiliation, and clinical interest.
  • User tools to continuously curate and maintain robust provider profiles staff updating provider profiles external authoritative sources, provider outreach campaigns, and internal workflows to prioritize those providers that still need manual research.
  • Value-based care plan management capabilities that support unlimited numbers of plans as well as the individual providers’ participation in these plans, including roster management and reporting.
  • Service line management powered by a thorough and detailed clinical taxonomy to categorize individual providers by specialty, subspecialty, clinical terms, and consumer-friendly search terms.
  • The ability to securely share these provider profiles to both internal customers (health system websites that offer Find a Doctor search capabilities, EHRs such as Epic and Cerner for billing purposes) and external customers (individual consumer-members of a clinical network, or employer-hosted websites supporting narrow network participation).
  • Location management capabilities that track all aspects of providers’ facilities, including address, other providers who practice in their locations and their specialties, tests and procedures offered, hours of operation, parking information, driving directions, language translation services available, etc.
  • A national repository of pre-built profiles of all providers, supporting a simple enrollment process as providers join CINs, ACOs or assume new health system affiliations.

Such a platform should support multiple departments’ provider data needs, including marketing, value-based care, patient operations, and financial operations, to gain the benefits of what has previously been siloed provider data management.  A rising tide lifts all boats: all these departments will benefit by a platform which supports the curation of this data for the good of the whole health system.

Healthcare is undergoing seismic changes as the industry shifts to value-based care models, which will continue to drive demand for better and more sophisticated tools to manage provider information. Healthcare networks’ success is dependent on investing in a platform to manage their most precious asset – their providers.

Edited by Ken Briodagh
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