Provider Data: A Fundamental Need for Collaboration

March 2016

Reliable provider data is necessary not only for care delivery, but also for efficient financial processes in healthcare. The need for accurate and timely provider data is continuing to grow. The healthcare industry is discovering new ways to share responsibility for quality provider data as government programs expand, new payment models evolve, cost pressures heighten and demands for transparency increase.

Executives Tim Kaja, SVP at UnitedHealth Group and Mariann Yeager, CEO of The Sequoia Project recently participated with CAQH in a panel discussion about provider data at the eHealth Initiative (eHI) Annual Conference in Washington, DC. The session explored how each organization is using provider data, challenges they have faced, and how they are overcoming some of these challenges through internal and external collaboration. Several key themes emerged from the discussion.

The Market Requiring Provider Data is Changing Rapidly

New federal and state requirements are driving transformations in the provider data arena, which is forcing the market to think differently and adapt to these changes. In addition, new payment models require interoperability and more accurate data. There was agreement among the panel that real-time data accuracy is the future of the market. Both consumers and providers will demand improvements.

The Industry Needs a Collaborative Provider Data Strategy

Current approaches to provider data management are not sustainable as costs and quality concerns have not yet been adequately addressed. Existing improvised approaches do not sufficiently consider common use cases, nor address the business problems around provider data. To achieve success, the industry needs to agree on a national strategy; one where stakeholders work together to determine scalable solutions that resolve known challenges.

There Should be a Shared Definition of Provider Data Quality

What is the definition of “high quality” provider data? The industry has not yet defined acceptable quality. Only when the industry crafts a widely-accepted definition can there be a shared effort to move toward that end. Since provider data is essential to interoperability, a common definition should be created through a collaborative effort that includes national, state, public and private input.

CAQH is planning an interactive September Summit to determine a path forward for provider data. Discussion topics may include provider directories, provider enumeration, data quality, and essential partnerships. Those interested in receiving more information about this invitation-only event may contact

CAQH Program: