What Is Ahead for Credentials Verification Organizations (CVOs)?

Author: Stephen McClure, Content Writer, HealthStream

This blog post is based off of a Thrive18 presentation by Vicki Searcy, Vice President of Consulting at VerityStream.

At VerityStream, we are committed to making sure our clients get the most out of their CVO. What’s currently an effective CVO must change as the nature of the services it provides is transformed by the needs of the healthcare industry. Nothing demonstrates this need for flexibility more than how CVOs have changed from their inception.

The Beginning of CVOs

The earliest CVOs were started in the 1980s, primarily by professional organizations, hospital associations, and medical societies to manage information about individual members’ professional credentials. However, many organizations were reluctant to use a CVO until the late 1980s when the Joint Commission established the conditions under which a CVO could be used by hospitals, circumstances similar to what is published in the current accreditation manual glossary for hospitals.

The early 1990s saw a big increase in the use of CVOs with the introduction of National Committee for Quality Assurance (NCQA) standards for managed care organizations, which required physicians who participated in managed care to have a hospital affiliation. Though this requirement was eliminated a few years later, it resulted in large numbers of applicants for hospital membership/privileges. Through the middle of the decade, after the NCQA introduced a certification program for Credentials Verification Organizations, the industry experienced a proliferation of medical society-based, hospital association-based, health plan-based, and commercial CVOs.

By the early 2000s, health systems were creating their own internal CVOs, and the Council for Affordable Quality Healthcare (CAQH) was formed as non-profit alliance of health plans and associations collaborating to streamline the business of healthcare. The passage and implementation of the Affordable Care Act (ACA) by 2010 had a significant additional impact on credentialing. The growing numbers of Accountable Care Organizations (ACOs) and the trend of more employed providers meant that the timing and efficiency of credentialing was more important than ever.

The CVO Landscape Today

CVOs now have reached a state of maturity, and there are few remaining medical society- or hospital association-based CVOs. Many are commercial and Health Plan-based, and most health systems have established a CVO or are in the process of doing so. Certification of CVOs is further evidence of systematization. Fully 189 CVOs have some form of NCQA certification, and 3 are certified by URAC, an independent, third party healthcare quality validator. The typical CVO does both hospital and managed care credentialing and is in the process of moving to electronic processes from paper-based systems. A characteristic group of services provided by many CVOs includes application management, verification, and expirables management.

CVOs face significant issues as healthcare organizations experience growing resource strains, such as:

• How to standardize operations after mergers and acquisitions
• Which providers get credentialed and privileged for clinically integrated network growth.
• Supporting telemedicine and telehealth
• Competing needs of credentialing, provider enrollment, and health plans
• Greater urgency for effective, faster credentialing
• Increasing organizational data needs
• Using metrics to improve and demonstrate success
• Improving provider satisfaction with credentialing

Where is the CVO headed?

As credentials verification matures, this function will undoubtedly change. Here are some of the questions every CVO will need to answer:

• Does the CVO acronym still work for an organization that does much more than just credentials verification?
• Centralization of CVO services keeps expanding. How do we effectively meet expanded needs that include enrollment, privileging, FPPE, OPPE, and high-level decision-making?
• As metrics become more available, how should we use them?
• What changes will data-mining and predictive analytics tell us to make?
• Medical staff mergers will continue. How does this change the way we make decisions?

Electronic processing will accelerate, by necessity. What does that mean for changing how we do things?