Next-generation healthcare provider data management: Why it’s a must-have

Stephanie St. Thomas
August 4, 2020
It may seem counterintuitive, but getting accurate healthcare provider data into the hands of those that need it? It’s also a struggle for providers themselves.

Is this specialist actually part of our ACO?

What’s the highest quality and most cost-effective imaging center for this patient?

Most providers and their teams experience difficulties with data as they complete key tasks such as referrals or helping patients stay in-network. Provider data is either unreliable or unavailable (locked inside some other IT system, rather than being present when it’s most needed).

Unreliable & inaccurate

Provider data churn 30% year over year, creating inconsistencies that are hard to monitor and maintain. The remaining data is full of inaccuracies as well. Overall, provider directory data is 50% incorrect.

Siloed and hard to maintain

In the typical enterprise system, provider data is siloed in separate locations, such as credentialing, network and contracting applications, marketing CRM, and the electronic health record.  

Data isn’t convenient to use during decision-making—not for doctors, the referral management team, or for patients. Digital health companies are discovering this as well.

Financial losses

The provider data situation is both frustrating and financially damaging. Industry research shows that the majority of healthcare organizations lose 10-20% of revenue because patients seek care beyond the organization.

This leakage directly ties back to data. A provider may struggle to find a referral that’s in-network with the patient’s insurance, close to their home, and that offers expertise in treating a specific medical condition. If a practice can’t complete a satisfactory referral, a patient is likely to find care on their own.

A negative or confusing referral experience also affects a patient’s brand loyalty. Patient experience has five times the impact on brand loyalty as traditional marketing tactics.

How accurate, distributed data helps providers

A real-time, seamless layer of reliable provider information can help healthcare organizations of all sizes and structures achieve positive changes to operations, financial performance, and patient experience, including:

Digital front doors that earn patients’ trust. High-quality provider data makes it possible for patients to schedule their own appointments, without confusion related to provider affiliation or insurance networks.

Organizations capture value and prevent referral leakage. Whenever a referral is made, the provider—or their team—will be able to steer patients to high-value providers that accept their insurance and encourage patients to receive care within the healthcare organization. Accurate, available provider data makes it easier to administer an ACO and to uphold value-based care during the referral process.

Healthcare enterprises can bridge telehealth to in-person care. Providers can deliver clear care navigation in any workflow, bridging the gap between in-person care and telehealth, along with other digital health applications.

Provider knowledge is shared across the organization. Rather than being siloed, data and knowledge about providers is centralized and well-distributed across the organization.

These positive changes can earn greater customer trust and loyalty, support higher quality care, and lead to financial benefits.

How Ribbon transforms provider information

Ribbon Health is a seamless API layer for the source of truth on provider information. With real-time, comprehensive data, provider organizations are making gains in patient satisfaction and business performance. A few examples:

A large primary care group that spans multiple states uses Ribbon to power positive changes to their referral processes. They use Ribbon data within their referral management system to

  • Streamline provider search
  • Simplify insurance network search to inform patients’ health plan choices
  • Flag preferred providers to build a preferred referral network

At the conclusion of a telehealth visit, a referral to in-person care is sometimes needed. Ro, a leading telehealth company, uses comprehensive provider data from Ribbon to guide patients to in-person care when needed. With Ribbon, Ro-affiliated providers can help patients easily find the best in-person care, based on specialty, services, geography, and insurance network.

A consumer-facing care navigation application was challenged by incomplete, inaccurate provider and network data and lack of insight into provider quality. With Ribbon, the platform now features accurate, reliable provider data and quality metrics. Consumer engagement with the platform is increasing, and the company is able to drive patient volumes to preferred providers, who are both high-quality and cost-effective.

These positive changes are possible because Ribbon is a simple, back-end data solution. Ribbon data can power any “find a doctor” use case, across any workflow.

Providers have finally met provider data that’s real-time, comprehensive, and distributed.

And it’s the beginning of a beautiful friendship—improving cost, quality, and patient experience.

To learn more about how Ribbon helps providers, download the one-pager here.

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