Introduction by Leonard George, CEO Azulity
In this ‘Expert Insights’ edition, it gives me great pleasure to introduce one of our resident experts in the field of Master Data Management (MDM), and in particular, Provider Master Data Management in Healthcare – Brigitte Workman.
Brigitte is the recipient of the 2018 HCPro Credentialing Resource Center Case Study Award for MDM excellence. She is a Gartner “Top Quadrant” MDM Healthcare business partner. She brings over 20 years of experience advising C-Suite executives regarding the alignment of technology and organizational incentives and guides on-the-ground execution of large-scale technology initiatives.
Here, Brigitte shares some of the benefits Provider Master Data Management offers for health systems and provider networks. She also provides guidance on how health systems can overcome some common data-related challenges through effective Provider MDM solutions.
Provider MDM is changing the face of healthcare in the United States. Here’s how, by Brigitte Workman.
How Do You Know When You Need Master Data?
I had just completed my case presentation on Provider Master Data Management (MDM) at a conference for medical professionals. A well-suited executive came up to me and asked,
“Our mergers and acquisitions are moving at a rapid pace; the other teams can’t keep up. Can Master data help?”
It got me thinking about other healthcare executives across the country trying to figure out the right tipping point at which their organization may need a provider MDM solution.
I answered the executive’s question by posing just two simple questions:
1. Do you have several Provider Credentialing teams?
2. Is your medical staff data separate from your payer data (i.e., not fully integrated)?
If the answer is “Yes” to any of the above questions, you may want to look into what Provider MDM can offer.
Provider Master Data Management or MDM simply refers to the processes, services, and technology in place to manage your critical provider data.
Most providers find the process frustrating. Oftentimes, a lengthy and cumbersome onboarding process can lead to delayed revenue streams.
During the transition, apart from the providers themselves, it can be an unsatisfactory experience while delivering essential data to downstream systems in a timely manner. This includes pushing provider data to external business partners, regulatory and compliance reporting organizations, web directories (Find-a-doc services), networks, and more.
These issues are compounded by the sheer volume of provider data that large networks now have to balance, maintain, and update regularly. This is in addition to the increasing number of regulatory reporting requirements, exclusions, and now, preclusions too.
Health systems can significantly reduce costs and improve efficiencies by establishing and maintaining a Master Data Management (MDM) solution for their provider data.
This ensures consistent high-quality data, fewer errors, and the automation of many tasks that otherwise cause delays across the system.
By implementing a system-wide Provider MDM solution, organizations can integrate and streamline data from top-tier medical staff credentialing applications, EMRs, CRMs, ERPs, reference sources, and much more. Clinician directories that are otherwise fragmented across divisions can be unified as well.
There is growing demand for Provider MDM for health systems around the country due to the many advantages it offers, such as:
LOWERING COST AND TIME FOR NEW PROVIDER ON-BOARDING
$7,000 per day.This is the average cost of onboarding new providers to health systems. It can be time-consuming, often extending beyond 90 days, and takes the efforts of several cross-functional resources working together. There are many manual steps involved. These steps are accompanied by constant communication with external entities in an effort to share and validate professional data related to a provider’s education, work experience, and training. This data must then be verified by approved sources. This entire process is known as Provider Credentialing.
IMPROVING REPORTING AND BUSINESS ANALYTICS
For healthcare executives running large-scale enterprises, there is an enormous amount of data that flows within the organization and is exchanged externally to insurance providers and third parties. Additionally, when healthcare organizations work with external reference data, it adds another layer of complexity. Over the past three years, acquisitions and organizational growth have become more commonplace in this industry. Organizations struggle to integrate health systems that may be working with legacy systems.
As organizations continue to grow rapidly, groups within the organization must leverage data for their business analytics needs. Effective business analytics within an organization can help reduce operational costs, uncover new opportunities for growth, and facilitate better provider and patient experiences.
A direct consequence of a greater focus on data analytics is that the IT team begins to experience a large volume of custom reporting requests from various groups in the organization. For example, the Clinical Analytics and Reporting, Identity and Access Management, and Claims Management teams may all require data related to their separate analytical needs. Detailed reports for each team will contain varied fields that are individually structured can create challenges. Without proper data governance and a master data management structure in place, the lead time to meet the analytics requirements of business users increases significantly.
If the core data has missing fields, duplicate entries, or other issues, any business insights obtained from it are also flawed and potentially unreliable for business decision-making.
A master data management solution can increase the quality of data. It also makes data available immediately to Business Intelligence applications.
Other teams can then use the master data for predictive analytics, blockchain, and other modern technologies. This data works as a backbone for reporting and helps streamline the rest of the reporting requests, reducing the number of duplicate requests. Having a strong Reference Data Architecture with your Provider MDM solution also aids in managing the complexity of the data better.
Here are a few examples of how various health systems with which I have worked experienced these benefits through a Provider MDM solution:
- Using an MDM solution with workflow integration permitted the tracking of quality issues from the initial action to closure.
- A Provider MDM solution can also assist a health system in highlighting providers based on specific requirements at a time. In one instance, a particular health system wanted their providers to be ranked and prioritized in searches based on their specialties; the MDM solution offered that capability.
- Implementing a provider MDM tool helped develop the framework to create a centralized reference architecture. This platform allowed us to apply clear business rules within the tool for data categorization and management. The rules helped standardize critical data used by the organization.
An additional advantage is the access to technological innovations once an organization has a unified master data set for a fundamental domain.
The U.S. healthcare spend is through the roof and expected to reach $6 trillion in about ten years. Meanwhile, Americans as a whole are experiencing poorer health outcomes [Harvard Study]. This is one of the main reasons why large healthcare organizations around the country are focusing on improving population health outcomes.
Gaining insights to improve population health requires detailed analysis of health outcomes data, results from clinical trials, patient compliance with scheduled appointments and prescribed drugs, lifestyle, medical history, and much more. Health systems are beginning to invest in data management systems to mine their data for research.
FACILITATING NETWORK GROWTH AND EXPANSION
Megamergers are dominating the healthcare industry.
These mergers result in massive amounts of data shared across a variety of electronic health record systems, administrative systems, operations, and purchasing databases, as well as vendor and personnel management systems. This is no small feat to integrate.
In my experience, a robust provider data management architecture for your health system allows for much easier integration of data from new health systems, medical groups, and care models.
Let’s take the example of one of the nation’s largest health systems. This was a challenging undertaking. The organization had upwards of 25,000 medical staff and more than a thousand care facilities across seven states. They were expanding rapidly due to multiple mergers and reprioritizations, and I was brought in as a Senior Master Data Management consultant to help them organize and integrate their data.
When we completed the enterprise-wide data program and implemented Provider MDM, clear rules were set for managing provider attributes, solidifying on-boarding workflows, and alleviating data integration priorities. It helped standardize data across the organization.
Provider MDM solutions can reduce the time taken for data integration between networks from several months to just a few weeks.
However, provider data management had taken a backseat until recently when health systems realized that effective provider management could provide them with a clear advantage in the competitive market.
Improving patient experience involves mapping patient journeys throughout the continuum of care and incentivizing them to stay within the network. An effective provider MDM solution can provide core data used by virtually all systems in the organization and increase provider workplace satisfaction.
ADDRESSING GROWING PATIENT DEMAND FOR PROVIDER INFORMATION
An overwhelming majority of patients select their caregivers based on whether they are in-network or not. As health systems grow and expand rapidly, how many patients drop off due to a lack of access to the right information? How many people experience a delay or a rejection in medical claims payments when providers are in transition between networks, or when a growing health system finds it challenging to integrate their data?
Health systems that invest in quality Provider MDM can offer updated in-network provider information to their patients as readily as the data is available from upstream systems.
This speaks volumes to the level of commitment to providing quality care to patients. With streamlined processes, MDM offers provider networks an opportunity to build longer-lasting relationships with their patients.
CONCLUSION
50% of all healthcare organizations will invest in sharing and analyzing real-world data for use across their organizations by the end of 2019 [Forbes]. Population health management, the optimization of patient health outcomes and provider experiences, and the automation of operations will be the top priority.
To rely on the results of the analytics is to place trust in the underlying data sets used. In this competitive world, investing in provider master data management upfront could help health systems realize cost-effective solutions and stay ahead of the competition.