CAQH Convenes Participants in Industry-Wide Collaboration
A cross-section of healthcare leaders has begun work on a wide-ranging effort to improve the accuracy of provider data for both industry stakeholders and patients. Convened by the non-profit alliance CAQH, the Provider Data Action Alliance will develop a roadmap that articulates a vision and actionable strategies for obtaining and sharing better information. Alliance participants represent health, dental and vision plans; provider organizations; health systems; government; and health information exchanges.
High-quality provider information is essential to conducting many of the foundational processes in healthcare, from paying claims to producing provider directories. Despite the considerable investment by the healthcare industry to attain and manage that data—currently estimated at more than $2 billion annually—inaccurate information is common. For example, a report released earlier this year by the Centers for Medicare & Medicaid Services (CMS) found that 45.1 percent of practice locations listed in on-line provider directories were incorrect.
“We are proud to take part in creating a more cohesive healthcare system,” said Michael Dowling, chief administrative officer of Montefiore’s Care Management Organization, the unit that handles credentialing and provider information for Montefiore Health System, an Alliance participant. “When we break down silos in favor of shared approaches, we reduce administrative costs for all stakeholders, including the patients we serve.”
Working together, Alliance participants will develop strategies to address the challenges of ensuring accurate and timely provider information. These include managing data that changes frequently due to practice location moves, retirement or other life events. In most cases, providers must inform a number of health plans and healthcare organizations of each change, a redundant process that adds to the administrative burden for providers. Requirements for data collection vary depending on the stakeholder and state regulations. The need to increase provider engagement in the maintenance process is another key issue and focus of the Alliance.
Through this effort, the Alliance will explore how best to develop industry-accepted data definitions, improve maintenance processes and accountability measures, centralize data resources and foster greater regulatory alignment.
“Creating an operational, statewide capacity to exchange both clinical and administrative data efficiently and securely has made us acutely aware of the great variation and pain points in managing these large data sets,” said Tim Pletcher, Executive Director of the Michigan Information Health Network Shared Services and Alliance participant. “This is a complex problem, and the work of the Alliance will focus on critical use cases so that we can have the greatest impact in the shortest amount of time.”
The Alliance was a result of the 2016 Provider Data Summit, a CAQH-hosted conference where more than 100 industry leaders met to discuss provider data challenges. Attendees reached agreement on the priorities for improving provider data and called for further industry-wide collaboration. Summit discussions were informed by a white paper created by CAQH with support from Manatt Health, a leading health policy and research firm.
“Outcomes from the Summit show that diverse organizations are facing similar challenges with provider data. This Alliance is a collaborative effort to develop coordinated strategies and actively begin addressing these challenges,” said Robin Thomashauer, Executive Director of CAQH. “We are excited by the energy and engagement of the Alliance participants. Supporting their work reflects our own commitment towards ensuring that provider data better meets the needs of both industry and the patients we serve.”
CAQH will facilitate the work and development of the roadmap with the Alliance through the summer, with release scheduled for fall 2017.
Learn more about the Provider Data Action Alliance and the challenges of maintaining provider data at www.caqhproviderdata.org.