Provider data learnings part 1 – Improving provider directory data quality when there is scarce, missing or non-existing data

Our journey from a direct-to-consumer app to validating provider data has given us a lot of (sometimes surprising) insight around provider directories, especially in terms of data quality and managing complex provider data systems. In the upcoming posts, we will share key learnings from our provider data validation work, which has expanded nationwide.

In this first piece, we will talk about the misconceptions that still exist around collecting provider data, the overall data quality, and how to fix your provider directories when there is missing data.

When it comes to provider directories, it is a common misconception to think that someone, somewhere has the data needed. A lot of people have the notion that provider data is somewhere, just not in some their system.

The way this problem has been “solved” in the past involved different players in the market swapping data with each other. Unfortunately, much of that data is incomplete and even collecting the best data sets out there couldn’t get you all the data you need. Credentialing systems have been the usual go-to source in the industry, however, they only get updated every few years and are missing most of the attributes now required by regulators and desired by consumers.

In fact, during our AHIP validation pilot we learned that over 40% of the data attributes required in health plan provider directories were missing altogether. For example, information about practice’s office hours, staff languages and specialties were missing, mostly because the groups or teams have simply never collected this information. For the end-user, the patient in need of care, this kind of data is critical to accessing care.

Data gaps in provider directories improved by up to 70% with modern tools that enabled providers to easily update their data.

Missing data includes:

  • Office hours
  • Staff languages
  • Specialities
  • Middle Names
  • Additional Phone Numbers
  • Fax Numbers
  • Emails
  • Websites
  • Types of Affiliations
  • ADA Accessability

 

 

So how do you efficiently collect the data that is missing? Instead of licensing data from other vendors, the ideal place to get the data you need is directly from the source, that is, from the practice managers or providers themselves. Without talking directly to providers on a consistent basis to collect their data, it cannot be assumed that other data sets will guarantee clean and accurate information to intake.

The first step towards improving provider directories is to leverage validation services and tools designed to accommodate the process of attesting, while reducing the administrative burden on the provider. Modern technology enables an approach where the information needed can be collected once on behalf of the provider and shared with every health plan who needs access to it.

Health plans often do not have the necessary resources to collect data on their own. As such, it does not make sense to undertake an effort that could be more effective done collectively as an industry. Ultimately, the consistent collecting process for all parties will improve the data quality, fill the missing gaps and benefit the healthcare ecosystem as a whole.

Would you like to learn more about BetterDoctor’s provider data validation services? Download our White Paper on “The Challenges behind fixing provider directory data” and get in touch to learn more.

Pauliina

My name is Pauliina Alanen and I take care of our developer community. I want to discover new ways tech can improve healthcare, together with our developers. My passions lie in working with people and bringing transparency to things that lack it. You can find me in our meetups, hackathons and on Twitter @palan3n or @betterdoctor.