Healthcare organizations face a data deluge and health plans may be one of the hardest hit. Health plans grapple with managing both member and provider data – a herculean task considering the sheer volume of data flowing in and out of systems each month. Health insurers generate a staggering 1 petabyte of pricing data monthly, and healthcare data itself grows at an annual clip of 47%, now accounting for 30% of the world’s data1.
This data explosion isn’t just a headache; it directly impacts a health plan’s bottom line.
- Duplicate member records can lead to significant risk for a payer organization, resulting in inaccurate billing, denied claims, and even legal liability, while causing friction between payers and their provider network. Correcting the resulting errors increases administrative costs.
- And when it comes to the financial implications associated with inaccurate provider data, it can cost $8-$15 per provider annually to research and update. For plans managing 100,000 providers, that’s a potential $800,000 to $1.5 million annually2 – a significant cost that can be mitigated through effective data management.
Furthermore, data directly impacts the relationship a health plan has with its members and their retention. In fact, “49% of members say that experience factors made them leave a payer, including inaccurate or inconsistent information, unanswered questions, poor experiences using digital tools, poor customer service and discomfort with how payers used their personal data.”3
The No Surprises Act: A compliance imperative
The No Surprises Act protects members from surprise medical bills and ensures transparency in provider directories. Compliance with these regulations stretches beyond significant penalties; it’s interwoven with other key initiatives like member trust and operational efficiency. Accurate data management is crucial, necessitating regular updates and verification of provider information to avoid billing discrepancies.
Non-compliance comes with hefty price tags – penalties can reach $10,000 per violation. This financial burden compounds when considering reputational damage and member churn. Here, effective data management becomes a shield against penalties and a tool to enhance service quality, leading to higher member satisfaction and retention.
The four central tenets of a robust provider data management strategy
While many of your teams are likely hyper focused on these core tenets of provider data management, conquering the data challenge requires a multifaceted approach encompassing:
- Advanced data analytics: Dive deeper into your data to uncover hidden patterns and trends. Machine learning and predictive analytics can anticipate and proactively address inaccuracies before they snowball into significant issues.
- Automation and integration: Leverage automation to streamline data maintenance. Automate provider directory updates and integrate provider data with other systems for seamless data flow across your organization. This minimizes discrepancies and improves overall consistency.
- Rigorous data governance: Establish clear protocols for data entry, validation, and periodic review. Designate data stewards responsible for overseeing data management and adherence to governance standards. Regular audits and quality checks are vital for maintaining high data standards.
- Continuous monitoring and improvement: Data management is an ongoing journey. Implement real-time data quality monitoring tools and establish feedback loops to learn from past errors and continuously refine your practices. This fosters a culture of continuous improvement, allowing you to adapt to evolving regulations and data challenges.
Data is the competitive advantage
Effective provider data management isn’t just about compliance; it’s a strategic asset that fuels operational efficiency and member satisfaction. By leveraging advanced analytics, automation, robust governance, and continuous monitoring, you can transform provider data from a burden into a competitive advantage. This proactive approach not only mitigates risks but also enhances overall plan performance, boost provider satisfaction, and enhances member experience, positioning your organization for success in the data-driven future of healthcare.
Interested in digging in deeper? Download our recent white paper, “Why identity is the missing piece of your successful data and analytics strategy.”
