Provider Data Management - "The Source of Truth"

An advantage of spending most of my professional career in healthcare is a perspective on what has changed over the years – and why. As I’m writing this, I’m listening to a webinar about the changes that have occurred in the past months in many organizations related to transitioning to remote/virtual meetings from in-person meetings. We have gone from credentials committee meetings where the members sat around a conference table (often during lunch) with a stack of paper credentials file for each member to review during the meeting to processes where members now have access to credentials files electronically, and review their assigned files in advance of a meeting that is conducted via the use of technology that allows members to participate remotely. And – most organizations report that they will never go back to the old way of conducting meetings because remote meetings are efficient and can be very effective.

Provider data management has also undergone a transformation in most organizations. From my perspective, we have gone from a time where credentialing software (for those organizations that actually had software vs. a rolodex) was stand-alone and not interfaced with other applications. In fact, in many organizations, the medical staff believed that they “owned” the data about members of the medical staff and were very protective of sharing any data at all. Data collected during the early days of automation was limited to the data needed for credentialing purposes and requirements of medical staff organizations. For example, in the past, software functionality to track committee membership and attendance was very important. Today, that functionality still remains a component of provider software but is certainly not considered to be a key software feature.

What is "The Source of Truth"?

Most organizations today require that processes are established to ensure that data collected when new providers are recruited and credentialed is the “source of truth.” This provider data is downloaded to other business applications. Of course, this means that the data initially collected (typically via application forms) must meet the business needs not only for credentialing and privileging processes, but also the data requirements for provider enrollment, claims billing, marketing, etc. The focus on being the source of truth for provider data has been transformational for most departments responsible for collecting and maintaining this data. This has elevated the status of credentialing departments and medical staff offices in many organizations. Previously those departments were seen as necessary (and valuable) because of their responsibility to meet accreditation and other regulatory requirements related to credentialing, privileging, and medical staff organization functions. Now those departments are viewed as critical to the organization’s revenue stream because of the data that is obtained, verified, and maintained. Contributing to the revenue stream has definitely had a tremendous impact on the importance of the medical staff office/credentialing department.

The 2020 Annual Report on Medical Staff Credentialing revealed that slightly over 93% of respondents identified that provider data management (defined as capturing, validating, analyzing and managing data on employed, affiliated and referring providers) was a high priority.

Only process improvement (defined as accelerating cycle time, reducing variability, automating when possible and improving reliability) came in as a higher priority at just under 97%.

What does this mean for medical services professionals?

It means that developing expertise in provider data management can have a significant career boost. Even if you don’t want a career focused on entirely data management, having a good working knowledge of what provider data is needed by your organization, what departments need provider data and how they will use the data, definitions of that data, and how the data is obtained, verified and maintained will make you a more informed, valuable member of your department. As they say…knowledge is power. And more knowledge about provider data management will help to position you for future opportunities.