[ad_1]
Accurate and up-to-date data on health care providers is an integral part of health plans to guide their members to the most appropriate care and for providers to deliver this care effectively, thereby reducing costs, improving quality care and improving outcomes.
Collection and consolidation of provider data (names of physicians, practice locations, office hours, hospital affiliations, etc.) providers. Interoperability has introduced several policies that require having an up-to-date supplier directory. This forces CMS-regulated payers to make key attributes of their supplier directory public through a standards-based API. For suppliers, the focus is now on the digital contact information policy under which CMS now publicly lists suppliers who do not list or update their contact information.
Creating and maintaining a single, reliable repository of up-to-date vendor data is critical to supporting the required directory updates. However, this cannot be treated as a one-time manual exercise, as supplier data changes so frequently. A 2016 IDC Health report found that 2% of provider demographics change every month, with 20-30% of physicians changing affiliation every year and 5% of physicians changing status – losing their license, retire, die or receive sanctions, for example – on an annual basis. The frequency with which this data changes makes it all the more important for payers and providers to remain diligent in maintaining their directory.
Beyond changes coming from inside your organization (payer or supplier), supplier data updates come from several external sources, such as national databases, state data, medical associations , third-party claims data, directly from a vendor’s office or from different departments within a plan. Integrating this external data into existing systems can be difficult as the systems support different processes.
Standards are also changing, as seen with interoperability policies, which result in penalties for both payers and providers for not providing access to up-to-date provider data. Currently, financial penalties target payers who do not revise their directory within 30 days of a change or remove vendors who cannot be verified.
New policies and laws introduced continue to tighten the timeline for the update process; the Consolidated Appropriations Act of 2021 (HR 133) further narrows the window for payers to apply updates to their directory from 30 to 2 working days by 2022. Suppliers and facilities are also required to notify all plans for any material changes to their supplier directory information in a timely manner.
Beyond CMS penalties, HR 133 further states that if a patient relies on incorrect directory information, the plan cannot charge more than network rates and apply any payment to network deductibles and maximums. refundable.
Establishing a Vendor Data Repository (PDR) provides the organization with a single source of vendor data that has been consolidated across various applications and integrated into a trusted view of the vendor. PDR allows business rules to link this data together so that it can later be defined by the people closest to the data: stewards and other subject matter experts. Having all vendor data in one PDR provides visibility into data inconsistencies between systems and makes it easier to track data changes so that downstream applications can consume the changes they want, at the frequency. that they can support.
IQVIA has found that it is difficult for many organizations to find the time and budget to invest in creating their own RDPs to meet the needs of their organization. Despite the challenges an organization may face, investing in a PDR can prevent inaccuracies within your system. For example, a review by the Centers for Medicare and Medicaid Services of 5,602 providers in 10,504 locations found that almost 50% of the listed provider directory locations had at least one inaccuracy, including providers located in locations other than those listed, incorrect phone numbers and suppliers. not accepting new patients despite directories indicating that they were. Even a small gap can be costly: $ 100 per day per person affected by a non-compliant qualified health plan, and up to $ 25,000 per day per Medicare Advantage beneficiary.
Ultimately, patient care is most affected when provider data is disorganized; it can also only improve with the establishment of a precise, organized and up-to-date PDR. In addition to providing advanced interoperability, a current healthcare PDR also enables faster access to provider information at the point of care, improves coordination of care, and promotes better understanding of networked providers. Good data governance balances supplier relationships with other data entities: healthcare organizations, plans, specialties and patients.
In order to get started on the road to establishing a PDR, you need to identify business initiatives or business processes that are significantly affected by inconsistent, inaccurate, or incomplete vendor data. These can be internal initiatives, such as system upgrades where the engine lowers costs and increases operational efficiency, or network expansion where the benefit is increased revenue, or even external engines, such as supplier directory mandates to avoid costly penalties for not having applied updates within 14 days.
IQVIA has helped many of our healthcare clients, including hospital systems, physician groups and healthcare payers, advocate for an investment in PDR, build a scorecard route for comprehensive master data management, create their own vendor data repository, and start data governance by establishing vendor data stewardship. Click here for more information on how IQVIA can help you meet your health data needs.
[ad_2]
