From 2019 to 2020, there was a 16% increase in patients who search online for healthcare solutions. We are confident that number has increased following the COVID-19 pandemic. The same Yext Patient Search Behavior Survey showed that 71% of people went to search engines first when trying to find care. Today, patients are empowered to find information through search and available data for affordable, appropriate care. But patients are at risk for delays in care when the provider data is filled with errors or inaccuracies. Your provider directory is your front door. The patients, members, and repeat satisfied customers rely on your provider directory to access care. So, is your front door helping or hurting you today? Data automation for provider directories is worth the investment to improve patient experiences and reduce spend.
How Much Is Spent Maintaining Provider Directories?
The most current industry research data of 1,240 physician practices, surveyed in September 2019, showed that $2.76 billion is spent annually updating provider directories. Therefore, physician practices alone are spending about $1,000 every month trying to achieve provider data accuracy. This spend increases significantly for larger healthcare organizations with larger administrative needs.
What is the Provider and Health Plan’s Responsibility to Accurate Provider Data?
New regulations of the No Surprises Act require better stakeholder coordination, process automation, and error detection. CMS is making these efforts to ensure the provider data is up-to-date and accurate. But, they aren’t responsible for making sure your provider data is validated and verified. Both the health plan and the provider have responsibilities for better data governance.
Health plan responsibilities to ensure accurate provider directories:
- Improve how data is collected and what is collected for better data governance.
- Invest in reliable provider data automation for quality and streamlined data processing.
- Make plan participation easier and more simple.
- Streamline network status integration and provider directory updates to improve the accessibility of affordable care for plan members.
- Set up routine data vetting and resolution best practices for data discrepancies.
Provider responsibilities to ensure accurate provider directories:
- Establish a timely cadence for provider contact information updates. This will support patients better for necessary access data such as practice location, clinician accepting new patients, clinician phone numbers, physician status changes, etc.
- Create a feedback loop or means for data sharing to health plans. In turn, it is easier to report data inaccuracies and communicate opportunities for process improvements.
- When pulling from multiple practices or recruiting practitioners, ensure provider data is from a trusted data source. In doing so, it is possible to achieve a quality data directory.
- Define and ensure protocols exist for handling, submitting, and managing provider data to health plans. This will help streamline time and create consistencies to the overall process.
What is My Provider Directory Costing Me?
It is costly to everyone when patients are unable to access or find the appropriate care. Additionally, when a provider’s data entry is inaccurate or has errors, the following is at risk for providers and health plans:
- A decrease in patient acquisition rate resulting in a potential negative revenue impact.
- An increase in patient and member frustration and dissatisfaction resulting in a decrease in patient and member retention.
- A delay in payment and an increased chance of being fined resulting in up to $25,000 per beneficiary for errors in Medicare Advantage plan directories. And, up to $100 per beneficiary for errors under federally run Affordable Care Act (ACA) plans.
- Financial penalties under the No Surprises Act (NSA) for payers and health systems, plus the cost of a lengthy and expensive Independent Dispute Resolution (IDR) process.
Why is it Difficult to Keep Provider Directories Updated and Accurate?
There are three overarching barriers that prevent keeping provider directories accurate:
- Data and process ownership: There isn’t one clear owner for data governance throughout the entire organization or process.
- Manual workarounds: The data is often handled and updated manually as organizations have created homegrown solutions and have not yet invested in provider data automation solutions.
- Decentralized data repositories: When multiple facilities exist, handling and managing provider data and frequent updates on physician information are difficult and overwhelming.
Although these difficulties exist, they do not need to become roadblocks. It is possible to access a single source of truth for provider records. Additionally, you can handle data complexity using automated workflows. Both will support better data governance when using a provider data automation platform.
Read this customer success story of a regional health system and how they improved their patient experience and data accuracy across referable clinicians.