Healthcare executives today are focused on adapting to the next generation of care delivery. They have come to the realization that re-inventing the business of healthcare as we know it requires new strategies and new tools. They’re under pressure not just to take small steps forward but rather to take massive leaps into an unknown future—and many are looking to emerging technologies to lead the way. According to a recent Digital Health Tech Vision report, 81 percent of executives are currently “experimenting” with emerging technologies like AI, blockchain, or virtual reality—and 41 percent believe that these technologies will have the greatest impact on their organizations in the next three years.
While it’s not surprising that executives are attracted to the buzz of hot technologies that have revolutionized other industries, there is a disconnect between today’s reality and the focus on virtual reality. The real-world truth that most executives don’t know is that their organizations don’t have the data “basics” well-established and in place to fuel innovation. More importantly, many don’t know that not addressing that data foundation, alongside those emerging technologies, will be extremely problematic and could even bring innovation efforts to a standstill.
One of those foundational data elements is complete, accurate provider data in a provider directory. Provider directories are not discussed as often as EHRs, data warehouses, or analytics platforms. Yet, they are just as important – and can even help to feed better data into those systems. While they are not considered “hot” or “innovative,” they are considered a must-have “behind-the-scenes” at health systems, where they are needed hundreds or thousands of times each day.
Provider directories are a crucial part of the data engine required to drive success in both fee-for-service and fee-for-value worlds – and that’s why they are a top priority in 2019.
Here’s what to know:
1. The critical role of a provider directory: The provider directory is a comprehensive single source of truth about which physicians and providers are in network or out-of-network. It includes detailed information on physician specialties, sub-specialties, accepted insurance plans, locations, and availability. Provider directories for more advanced organizations include cost and quality data on physician performance to help guide patient referrals to the highest value care. At healthcare organizations that don’t have accurate provider directories, that data often sits in a variety of siloed systems. It may be pieced together from EHRs, credentialing systems, billing data, or even marketing information. But more often than not, the much-needed data remains in disparate sources and incomplete, or loosely combined in static spreadsheets that are rarely updated.
Without a provider directory, physicians and their staff members are flying blind when referring their patients to specialists. For example, a primary care physician (PCP) may always refer to one cardiologist with whom the PCP plays a weekly golf game without knowing if that cardiologist takes a patient’s insurance, is in network for a value-based contract, or has expertise in the patient’s specific clinical condition. While that approach wasn’t so problematic in the old business of healthcare, it doesn’t work in the new business of healthcare. It’s neither an efficient nor effective way to deliver care. However, with a reliable, complete, easy-to-search provider directory, physicians and their staff can choose the right cardiologist for each patient based on accepted insurance, appointment availability, location, clinical conditions treated, and even tiered-rankings based on value.
2. The time for improvement is now—and the need is urgent: The consumerization of healthcare has put an increased focus on improving the patient experience and managing the entire patient journey, rather than just a single transactional encounter. Ineffective, inaccurate provider directories have been plaguing healthcare organizations for years. In the old business of healthcare, the problems that inaccurate provider data created were troublesome, but tolerable. However, in the new business of healthcare, the clinical, operational, and financial problems that result from incomplete or inaccurate provider data cannot be ignored. The pain is so great, with such major implications for the entire health system, that executives must take action. After all, healthcare executives today are facing new challenges, like taking on risk for the first time, building clinically integrated networks, and reducing costs while simultaneously improving quality and growing top-line revenue. These new challenges are also magnified by the overall uncertainty of national and state policy and M&A activity. In this ever-changing environment, provider directory problems move from manageable and behind-the-scenes to unsustainable and front-and-center.
3. Why inaccurate provider data is scary for patients’ health – and financial health: Without an accurate data source, how can physicians make the best, most informed decisions for their patients? How can they intelligently answer important questions like, which providers are in network; which physicians accept a patient’s insurance; which orthopedic surgeon specializes in shoulders versus knees; which ENT is taking new patients; and which specialist is the lower cost, higher quality choice for a patient.
However, it’s more important to recognize that inadequate provider directories don’t just lead to inefficient provider selection or frustrated physicians. A lack of easy-to-query, trusted data for providers to rely on contributes to high rates of patient leakage and millions of dollars in lost revenue. It leads to poor network performance, slow network growth, and lower amounts of shared savings. Ineffective directories also severely impair an organization’s ability to succeed in tightly aligned value-based care contracts, population health initiatives, and care management programs.
With that understanding, is true innovation even possible without first addressing the provider directory priority? It’s possible, but efforts will be less fruitful and less rewarding. Even more troublingly, provider directory problems could have dire consequences for organizations with already negative margins or those in hyper-competitive markets. They need to take action or may be forced to close their doors—and that’s not virtual reality, it’s actual reality.