An Interview with VerityStream, Michael Sousa
CredentialStream offers a unique combination of platform, content, and data that accelerates the credentialing, privileging, and enrollment functions. It was built in response to industry changes with the goal of equipping today’s hospitals and health systems to respond to those changes.
We recently sat down with VerityStream President, Michael Sousa, to learn more about some of the trends that have impacted the CredentialStream platform's development and gain an understanding of what healthcare organizations need to prepare for in the years to come.
Are you ready to learn more about the shifting landscape of the healthcare industry and what you need to do to prepare? If so…read on!
What are the biggest changes you foresee on the horizon for the healthcare industry?
I think that before we look into the future, it’s really important to understand how the industry has changed over the last several years. There are a few key trends we’ve noticed our customers grappling with. First is a massive shift to hospital-employed providers and an increase in acquisitions of medical groups. Physician practice owners no longer make up the majority of patient care providers. A study from the Physicians Advocacy Institute revealed that 42 percent of physicians were employed by hospitals in July 2016, compared to just one in four physicians in July 2012, and this number continues to grow.
Second, we’re seeing significant growth in the number of non-physician providers. According to the American Association of Nurse Practitioners (AANP), there are now more than 248,000 Nurse Practitioners licensed in the United States, and 89.9 percent are certified in primary care. Data from the National Commission on Certification of Physician Assistants indicates that there are 123,000 Physician Assistants, and about 25 percent are practicing in primary care. This growth improves physician productivity and flexibility for patients and healthcare organizations.
Third, healthcare organizations are in the midst of transitioning from fee-for-service to value-based care reimbursement models. This transformation dramatically amplifies the marginal impact of every decision to add a new provider or grant a new privilege.
How do these trends affect those responsible for credentialing, privileging and enrollment functions?
Collectively, these industry changes necessitate the reengineering of many functions including credentialing, privileging, onboarding, enrollment, and performance management and this will require solutions designed to support these processes to be rethought, reimagined, and rebuilt. And bottom line is, the growing number of employed physicians and non-physician providers means there will be more to do.
We recently surveyed 683 medical services professionals (MSPs) and almost half of the respondents indicated that an increase in employees was having an extreme or very significant impact on their organization. When providers are employed by a hospital, the hospital assumes many responsibilities. They take on the provider enrollment process, they often underwrite malpractice insurance, and their list of onboarding tasks multiplies significantly. These are major shifts that are leading to sharp increases in responsibilities and workload.
Health systems themselves seem to be evolving
Yes. Years ago, a health system, by definition, was a collection of hospitals. Today a health system still includes hospitals, but it has expanded to include a wide network of the people, institutions, and resources that deliver healthcare services. There’s a multitude of care settings including urgent care, retail clinics, labs, ambulatory surgery centers, behavioral health resources, rehab facilities, home health, long-term care, and more. This evolving continuum of care has changed what MSPs, Credential Verification Organizations (CVOs), and enrollment professionals need to be successful and what a solution like ours needs to deliver.
Health systems are now also offering health plans, accelerated by the Affordable Care Act (ACA) and the launch of Accountable Care Organizations (ACOs). So, today, when a health system needs a solution to serve as a single source of truth on its providers, it has to be able to support multiple care settings, provider enrollment, corporate insurance and malpractice underwriting, quality, OPPE/FPPE, network management and health plan credentialing. The solutions needed today are much different than what health systems were seeking and implementing a decade or more ago.