4 ways to weather the healthcare provider data blizzard

RHIA,Global Healthcare Industry Ambassador, IBM Information Management

In the plains of my home state, South Dakota, blizzards can prevent residents from navigating farther than a few hundred yards on foot amid blinding, swirling snow. As I look back over 2015, my customers’ persistent demands for a trusted, unified view of provider data remind me of how easily I lost direction in the winter winds of my early years. But even when we are caught in a blizzard of requirements for defining and integrating provider data, four constants can keep us on a straight course.

1. Define providers

Traditionally, the term providers has meant credentialed medical staff, but such a definition is too narrow to suit an evolving financial and clinical healthcare environment as it moves toward a wellness system. Thus providers may now be physicians, nurse practitioners, clinical social workers, rehab centers, mental health agencies and much more. Indeed, a provider can be an individual or an organization. But don’t look to the National Provider Identifier (NPI) system for a consistent, trusted view of providers. An NPI addresses neither the duplicity between individuals and organizations nor the broad definition of provider—as the Office of Inspector General says, “Improvements [are] needed to ensure Provider enumeration and Medicare enrollment data are accurate, complete, and consistent.”

2. Identify data sources

The shift to accountable care organizations, value-based healthcare payments and various other forms of financial risk sharing has created demand for integrated, trusted provider data, not least because data comes not only from hospitals or ambulatory center groups but also from Medicaid, pharmacy benefit plans, retail clinics, diagnostic centers and health plans. In such an environment, inventorying sources of provider data, as well as work processes that use a provider identifier, is paramount. Not surprisingly, a count of work processes commonly turns up several dozen providers—or even hundreds in large organizations.

3. Bring stakeholders together

Gone are the days when only the credentialing function, a billing system or a human resource system needed provider data. As the graphic shows, the diverse needs of a wide range of stakeholders help create the blizzard effect I hear customers describe. Amid such a whirl of competing priorities, political fiefdoms and mandatory collaboration, defining stakeholders, let alone ensuring their participation, can be a difficult task.

4. Maintain your focus

Mastering and integrating provider data can be a daunting task in a world awash with stakeholders and other interested parties, and even more so amid the diverse work processes that consume trusted provider data in a rapidly changing public- and private-sector marketplace. Rather than trying to navigate an entire blizzard of demands, I advise organizations to instead choose a couple projects or initiatives that need integrated provider data—then gather the stakeholders and begin.

“One-off” provider registries and directories are very common in modern organizations, ideally as a way of creating a consistent provider for a unique project. Yet such solutions combine expense and inconsistency even as they threaten to compromise compliance and analytics. Conversely, the rewards to be had by integrating and unifying provider data can be immense. Together, common definitions, efficient work processes and consistent, trusted provider data can create economic savings through trusted reporting and analytics.

Watch this short video to learn how IBM Master Data Management solutions can help you manage your provider data. After all, there’s no time like the present, even—or perhaps especially—in the blizzard of demands.

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