Provider Data Management: the key to member experience and cost savings

By
Meg McMenamin
October 12, 2022

Managing provider data is a critical competency of an effective and efficient health plan, and yet it remains a constant pain point.

Nearly 30% of provider data churns every year, making it nearly impossible to keep information up to date, especially for health plans managing data for thousands of providers. When I worked in Payer Contracting at Optum Care, I saw firsthand how challenging it was for health plans to keep up with ever-changing provider data management and the downstream impacts it had.

Improving Provider Data Management Addresses Key Challenges for Health Plans

These provider data issues matter – by not solving them, health plans face a few key challenges:

  • Increasing spend on provider data management year over year, with precious IT and operations resources diverted from other crucial initiatives
  • Frustrating member experience for those seeking care and finding incomplete or inaccurate information, resulting in lower member satisfaction (and reimbursement)
  • Difficulty managing the total cost of care when members distrust provider information and avoid proactively seeking care or aren’t guided to the highest quality care options
  • Risk of falling short on compliance with costly provider data management requirements and ever-changing regulations
Ribbon’s Unique Approach to Provider Data Management

Health plans are not technology organizations. Nevertheless, improving data and infrastructure is key to achieving business goals and delivering a positive member experience. That’s why I’m excited to work with health plans at Ribbon. Our Provider Data Management offering takes a unique approach to solving a pervasive problem that impacts so many individuals. What makes Ribbon’s approach stand out?

  1. Our Deployment Team – We believe solving the Provider Data Management problem requires sitting alongside our customers. We do not deliver a piece of software and walk away. We have a dedicated team focused on understanding your existing processes and data governance rules, because we understand that every health plan is unique in how they manage data.
  2. Our Robust and Flexible Data Model – Patients deserve access to comprehensive data on providers to make care decisions. To achieve this, we compile and process thousands of data schemas. We understand the complexity of provider data today and transform the disorder into actionable insights – plus surface the new wave of in-network digital health providers.
  3. Our Technology – We believe that machine learning and artificial intelligence play an important role in sorting the “signal from the noise”. Our methodology enables us to take hundreds of locations for a single provider and identify which location is the most likely to be correct with extremely high confidence, as well as which records are wrong, which is oftentimes just as important to clean up the messiness of provider data.
Health Plans Can Quickly Improve Provider Data with a Third-Party Solution

Improving provider data doesn’t mean that you need to completely overhaul your existing data, processes, or systems. There are a few different ways plans can partner with a third-party provider data solution to quickly improve your provider data management efforts and immediately drive impact.

  1. Roster Management decreases the operational costs of ingestion and normalization. Ribbon can ingest hundreds of rosters to combine data into one shared schema. Ribbon can automate the data normalization process to optimize ingestion, and apply targeted machine learning models to strengthen provider and location entity resolution.
  2. Data Scoring reduces administrative costs by automating the process of identifying inaccurate data points. Ribbon can score your provider directory to tactfully surface inaccurate data for verification, continually validate provider-attested data, and build a logic engine that checks provider data accuracy on a recurring schedule to ensure high quality data over time.  
  3. Data Enrichment drives member growth and retention with comprehensive provider data for more personalized care. Ribbon can enrich your existing provider dataset with additional data points like demographics, affiliations, cost, quality, and clinical focus areas to provide contextualized care and drive member growth and retention.

Ribbon Health is a data platform and partner that is reliable, flexible, and scalable. Get in touch with our team to learn more about how we fuel healthcare enterprises with actionable provider information and our Provider Data Management offering that includes roster management, data scoring, and data enrichment.

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