Industry Collaboration Crucial for Solving Healthcare Provider Data Challenges

November 2016

A unified approach to collecting, maintaining and disseminating accurate and timely provider data is critical to improving the quality and cost of healthcare delivery, according to a new CAQH white paper, “Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration.”

Provider data is used to perform a number of essential functions in the healthcare system, such as referring a patient to a specialist, paying insurance claims, credentialing providers and determining sanctions. The real-world effect of poor-quality data on consumers and patients has been recently highlighted through increased regulation to address the quality of health plan directories.

While the concept of provider data is straightforward, realizing a seamless approach for collecting and maintaining high-quality data has been elusive and efforts to do so have been siloed. Challenges include few reliable data sources, varying definitions of providers and a lack of quality benchmarks and accountability measures.

New market and policy forces, including those driven by the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act, have put additional pressure on the industry to resolve the problem, according to the white paper. For example, an increase in the number of health plan products developed for the exchanges, as well as additional regulatory reporting requirements have introduced complexities for health plans and providers to submit data with new elements and in different formats.

In the absence of an industry-wide “source of truth,” stakeholders have developed highly individualized processes for maintaining provider data, which have also led to higher costs. One analysis cited by the paper estimated that commercial health plans and providers alone spend at least $2.1 billion annually to maintain provider databases.

To begin addressing these challenges as an industry, the white paper identifies potential areas for collaboration that would enable stakeholders to collect and disseminate high-quality provider data. Multi-stakeholder alignment will be critical to avoid the continuation of fragmented investments. Consensus on the elements of a minimum data set, quality thresholds and data governance and accountability measures will also be needed.

“The industry will be much more successful in solving this problem if we can do so collectively, breaking down barriers and developing consensus on how to move forward,” said CAQH Executive Director Robin J. Thomashauer in a press release.

Download the white paper.

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