CAQH-Convened Summit Tackles Provider Data Problems with Industry Leaders

November 2016

More than 100 industry leaders from health plans, healthcare provider organizations, government, consumer groups and others participated in a CAQH-convened Summit on Sept. 29th to develop a path forward for solving healthcare provider data challenges.

The discussion was informed by the CAQH White Paper describing the current state of provider data accuracy and efforts to maintain reliable, high-quality data.

Keynote speaker Shantanu Agrawal, M.D. (pictured above), deputy administrator and director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services, and panelists throughout the day, highlighted areas of concern and described why there is an imperative to address these challenges now. Common themes included the rising costs of healthcare, an evolving provider landscape, new uses for data—such as testing new payment models—and a growing regulatory environment.

Summit participants also attended breakout sessions to tackle components of the provider data problem, focusing on specific use cases from provider directory development to network maintenance. Attendees worked in small groups to create an actionable roadmap for the future. In these sessions, participants developed recommendations for establishing provider data content guidelines, defining provider data quality and identifying collaborative approaches to provider data management.

Atul Pathiyal, Managing Director of CAQH Solutions, summarized the breakout sessions and identified potential areas for action at the close of the event. These included:

  • Developing a common vision for a single provider data solution that is scalable and pragmatic;
  • Identifying standard data elements;
  • Aligning the private and public sector to ensure regulatory objectives can be met by all stakeholders;
  • Developing a consistent interpretation for quality, especially to ensure there are no lags in the dissemination of the information;
  • Focusing carefully on specific use cases that can have a meaningful impact; and
  • Considering, in any solution, the impact it may have on providers and taking steps to reduce their administrative burden.

CAQH released an executive summary of the Summit that describes the next steps and potential areas for collaboration in greater detail. To learn more, visit www.caqh.org/explorations/provider-data.

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