The Strategic Asset of Provider Data

Provider data is not merely a collection of names and contact details; it is a strategic asset that underpins patient access, care coordination, and operational efficiency. Accurate provider data ensures that patients can easily find and book appointments with the right provider for their needs, thereby enhancing patient satisfaction and trust. Moreover, it supports healthcare organizations in optimizing their networks and improving care delivery.

Inaccurate provider data, on the other hand, can create a domino effect of inefficiencies. Patients may struggle to find appropriate care, leading to frustration and potential loss of trust in the healthcare system. Additionally, healthcare organizations may face operational challenges, such as increased manual data updates and IT support tickets, diverting valuable resources from strategic initiatives.

The Role of Master Data Management

While master data management (MDM) is important for overall data governance, provider data demands a specialized approach. MDM provides a framework for centralizing and organizing data across an organization, ensuring consistency and accuracy. However, provider data requires additional attention due to its complexity and the role it plays in healthcare delivery.

Integrating PDM with MDM unlocks powerful capabilities. It allows healthcare organizations to maintain a single source of truth, facilitating accurate provider directories, streamlined care coordination, and optimized network management. This integration also supports compliance with government programs, such as 340B, where accurate provider information is essential for maximizing reimbursements.

Challenges in Provider Data Management

Managing provider data is not without its challenges. Organizations often pull information from multiple data sources, creating complexity in maintaining up-to-date and accurate data across channels. This complexity is compounded by the need to ensure data is consumer-friendly, enabling patients to make informed decisions about their care.

Moreover, the “build vs. buy” decision is a common dilemma for CIOs and IT teams. While some organizations attempt to build their own provider data management system, they often underestimate the complexity and resource requirements involved. Outsourcing PDM to specialized vendors can be a more effective strategy, allowing internal teams to focus on enhancing patient experiences.

The Benefits of Provider Data Accuracy

At its core, clean provider data supports better patient-provider matching, ensuring patients receive appropriate care from a provider who best meets not only their clinical needs, but personal preferences as well. When data accuracy is poor it can lead to poor matches and unsatisfied patients. 

Accurate provider data also enhances operational efficiencies and reduces administrative overhead. By reducing the need for manual data updates, healthcare organizations can reallocate staff to higher-value tasks, such as strategic growth initiatives. 

Engaging Providers in Data Accuracy

Accurate provider data is important as you work to attract patients across channels (internally, on your website, and across the web), which is vital as our research shows that over 50% of consumers access three or more online resources when gathering information about their care options. 

Providers play a crucial role in ensuring the accuracy of their data. However, healthcare organizations must recognize the demands on providers and partner them with administrative leadership to prioritize and manage data elements effectively.

Collaborative partnerships, such as those offered by Kyruus Health, combine external expertise with your own resources to optimize provider data. This approach empowers providers, streamlines processes, and ultimately drives organizational success.

Accurate Provider Data Drives Value

In conclusion, accurate provider data is a strategic asset that drives significant value for healthcare organizations. By integrating provider data management with master data management, organizations can unlock powerful capabilities that enhance patient experiences and operational efficiencies. While challenges exist, investing in a purpose-built provider data management solution and engaging providers in data accuracy efforts are key to overcoming these hurdles.

As healthcare continues to evolve, the importance of clean and centralized provider data will only grow. Organizations that recognize this and take proactive steps to m

anage their provider data effectively will be well-positioned to thrive in the competitive healthcare landscape. Interested in learning more? Schedule time with a member of our team.

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Our foundational analytics offering, Core Analytics, laid the groundwork for delivering key insights, but we recognized that organizations need more control and flexibility to delve deeper into their data and shape it to answer specific, evolving business questions.

Advanced Analytics: Tailored, Powerful, and In-Depth

Advanced Analytics provides our clients with full autonomy over their data exploration, equipping organizations to:

• Create Custom Reports: Tailor dashboard and reports to address unique business needs, choosing metrics and visualizations that align with their strategic goals.
• Integrate External Data: Build a comprehensive 360° view of consumer behavior by incorporating external data sources for deeper insights.
• Export and Share Data: Send reports directly to stakeholders, integrate data with internal business intelligence tools, and export datasets for offline analysis.
• Adapt Reports to Different Audiences: Design and save variations of reports for different teams—from detailed analyst-focused data tables to high-level executive summaries.

These capabilities allow our clients to pivot quickly, respond to new questions, and gain a clearer understanding of member and patient behavior without waiting for pre-scheduled reports. While our foundational reporting remains a valuable option for many organizations, Advanced Analytics meets the needs of those looking to drive proactive, insight-led decision-making.

Six Guiding Principles for Impactful Analytics

This shift from limitations to possibilities brought new challenges. Feeling the weight of these possibilities, we moved past option paralysis by discussing many open-ended questions, such as:

What should reports look like?

Which metrics should they cover?

Which visualizations should be used to communicate those metrics?

How should raw data be processed to make insights easier to consume?

How frequently should we deliver reports?

Our north star during these conversations was impact—ensuring that whatever choices we made, the intent behind them would be making our reports more impactful to their consumers.

As we develop new analytics tools, we keep in mind six guiding principles that summarize past learnings and help us deliver impactful reporting. For organizations embarking on developing their own reporting, we share these principles with you.

1. Tell a story

Start constructing your report with the story you want to tell in mind. Once the story is identified you can begin to discuss the metrics and visualizations that best tell the story.

The activity of outlining, discussing and iterating on the narrative before beginning report development not only elevates the quality of the final report, but it can save valuable time. Including stakeholders and eventual end-users at this step of the process is definitely encouraged.

For additional resources here, many of our analysts have read Cole Nussbaumer Knaflic’s storytelling with data multiple times, and highly recommend it!

2. Target a specific audience

Those who consume your reporting will vary in technical expertise and familiarity with the data you are presenting, so keep your target audience in mind and tailor the story to them. It could be that you develop multiple reports that speak to the same topic, differing only in the targeted audience.

There are many strategies for how to develop reporting depending on the intended audience, including which visuals to use, how many colors to use, and report length, to name a few. There is an entire chapter devoted to the audience in Knaflic’s bestseller, mentioned previously (see chapter 4). However, the mere practice of identifying and being mindful of your audience during development goes a long way.

3. Follow a well-designed, consistent layout

Once you’ve outlined your story, identified your audience, and have selected metrics and visuals that best complement that story, it’s time to design a simple, attractive layout that is consistent throughout the report. Once established, use this layout for all of your reports. Doing so will help your consumers see how reports fit into the bigger picture and will make new reports feel familiar.

4. Provide context

We’ve found that unless you are in the weeds with data day-in and day-out, it is easy to forget how metrics should be interpreted or what they really say (wait, what does the bounce rate mean, again?). Help your consumers by including a glossary and definitions at the end of the report and spell out how to read each page (and, in some cases, what the take home is) on the page itself. 

5. Include comparisons

The latest data is more valuable when viewed through the lens of recent history. For all the metrics in our reports we provide historical trend lines and/or quick comparisons to recent history to assess if metrics are increasing or decreasing.

One question we’re frequently asked is along these lines: This metric is interesting…are you seeing the same for your other clients? This is an important question, since such a comparison is helpful in distinguishing signal from noise in recent trends. As a result, we provide a peer group benchmark that is hand-selected to provide a meaningful comparison for the metric on display.

6. Be automated

Regardless of the power of a report, without automation it will become a chore (potentially someone’s full-time job) to maintain. We design all analytics offerings with automation in mind. 

Our aspiration for automation does introduce some limitations. For example, the context we’d like to provide isn’t always able to be automated, so we have to say something else. However, the time saved with automation empowers our analysts to tackle important tasks and initiatives that can’t be automated, such as research, developing statistical models and ad-hoc reporting.

Looking Ahead: Data Empowerment for All Organizations

Advanced Analytics represents a significant step forward in our commitment to empowering our clients. With greater control over data, these healthcare organizations can create tailored reports, explore detailed member and patient behavior, and make informed decisions that drive patient experience and improve health outcomes.

While Core Analytics continues to offer reliable, structured insights, we’re excited to provide organizations with a solution that brings data to life in new ways. By combining customizable analytics with our six guiding principles, we’re equipping organizations to turn data into action and maintain a leading edge in patient engagement strategies. 

Healthcare organizations seeking to harness the full potential of their data can now do so with tools that match their ambition. Explore Advanced Analytics to see how you can gain deeper insights and drive meaningful impact for your organization.

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For AI to truly empower patients in finding the care they need, it must rely on clinical information that’s accurate and easy to understand. Comprehensive, clinically specific data forms a foundation that allows AI to bridge the gap between complex medical language and accessible, patient-friendly guidance.

Here’s how leveraging clinically standardized taxonomy strengthens AI’s ability to guide people to the right care, with greater ease and precision:

Enhanced Accuracy and Relevance

Using a clinical library with terms for conditions, treatments, specialties, and provider types means AI can deliver more accurate and relevant results. Clear, patient-friendly language helps remove ambiguity and ensures users find what they need without getting lost in medical jargon.

Improved Search Efficiency

With an organized library of terms, AI can quickly process search queries, leading to faster, more efficient results. This means less time spent searching and more time spent accessing the right information.

Consistent, Trustworthy Results

A standardized taxonomy promotes consistency across searches, which builds user trust in the results. People know they’re receiving reliable information each time they search, regardless of how they phrase their query.

Enhanced User Experience

Clinically specific and standardized taxonomy lets AI interpret queries with greater precision. This helps patients and members make well-informed choices about providers, services, and care locations based on accurate, relevant insights.

Scalability and Interoperability

Healthcare is always evolving, and so is Kyruus Health’s Clinical Library. By continually updating to match healthcare advancements, we ensure AI solutions stay current. Standardized terms also improve interoperability across platforms, supporting a coordinated approach to patient care.

With a robust clinical taxonomy guiding AI, healthcare organizations can deliver a more intuitive, helpful experience for patients, members, and providers alike. Kyruus Health’s Clinical Library is built with over 35,000 terms for symptoms, conditions, and treatments—covering both clinical and lay language. Curated and updated by our Clinical Team, this resource ensures AI-driven tools meet the growing needs of care access with accuracy, empathy, and efficiency.

The post Leveraging AI in Care Access: The Power of Clinical Taxonomy appeared first on Kyruus Health.

Putting Healthcare Consumerism into Practice 

When healthcare providers meet these expectations, the result is a higher level of patient satisfaction. Patients with better care experiences often have better health outcomes and are more likely to adhere to medical advice and treatment plans. For providers, this means meeting their goals of increased patient retention rates, more satisfied staff and a solid reputation. 

However, operational inefficiencies—such as cumbersome appointment scheduling, long wait times, and fragmented communication—often hinder these goals. These challenges can lead to frustration and disengagement among patients, making it difficult for healthcare organizations to meet their needs effectively.

To address these issues, improving digital patient engagement is essential. However, simply adding digital tools is not enough. In our recent research report Progress, Not Perfection: Care Access in the Digital Era, we found that 92% of surveyed hospitals and medical groups had adopted a digital tool for all of the patient management workflows included in our survey. Despite this, only 52% felt strongly that their patient management workflows were working well and 86% felt that their arrival management workflows were contributing to a negative patient experience. 

Download: Progress, Not Perfection: Care Access in the Digital Era

Implementing a Thoughtful Digital Strategy

Digital tools must be integrated into an intentional strategy that aligns with the organization’s goals and patient needs. By leveraging technology in a purposeful way, providers can streamline processes and enhance communication. This approach not only makes it easier for patients to access care but also fosters meaningful connections with their providers.

When digital engagement is implemented strategically, healthcare organizations can overcome operational hurdles and create a more seamless experience. Ultimately, this thoughtful integration strategy and technology drives better health outcomes and strengthens patient loyalty in an increasingly competitive market.

To get a jump-start on putting together a purposeful strategy, check out our five easy-to-implement recommendations for improving the customer experience in healthcare. 

1. Make a Positive First Impression.

It’s hard to overcome a bad first impression, especially when you only see many of your patients a few times each year. As noted in a study published in Health Communication, “the first impression has a strong impact on positive and negative judgments on doctors’ communication approach and may facilitate or inhibit all further interactions.” 

Employing friendly and competent staff increases the probability your patients receive a favorable first impression. Train these team members appropriately to ensure they have good patient-provider communication skills and accurately set patient expectations. 

Also, keep in mind that the patient registration process typically provides a patient with his or her first impression of a physician practice and is essential for ensuring you’re able to offer high-quality care. It can set the tone for the entire patient journey. 

2. Provide Patient-Centered Care.

Shouldn’t all healthcare be focused on the patient? Of course. The patient-centered care (PCC) approach, though, encourages individuals to be more active participants in their own care. As a collaboration between providers and patients, it strives to improve individual health outcomes while also boosting patient engagement and satisfaction. 

PCC doesn’t only benefit patients. Providers enjoy perks such as lower overall costs, improved resource allocation and fewer hospitalizations and readmissions. 

3. Communicate.

This one might sound too easy, but it can make a noticeable difference in how patients perceive you. Even listening to patients without interrupting them goes a long way in making the customer experience more positive. 

There’s research that has identified multiple ways communication can lead to better health outcomes, including reducing medication errors and hospital readmissions. Some studies indicate strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition and adopt preventive health behaviors. Additional advantages of effective communication in healthcare are:

• Improved quality of care
• Enhanced patient experience
• Reduced cost of care
• Boosted patient satisfaction scores
• Decreased stress and burnout for clinicians
• Fewer complaints and readmissions
• Improved staff teamwork and collaboration 

4. Be Transparent About Price.

It’s not unusual for patients to get healthcare bills that amount to much more than expected. They receive medical care without knowing the exact price, even though they face high and varying out-of-pocket fees for their care. No wonder they’re frustrated!

According to our 2024 Care Access Benchmark Report, 95 percent of consumers consider some kind of cost information when selecting a new provider, and 78 percent say they wish they had more control over healthcare costs. Along with reducing the cost of healthcare, price transparency has the potential to provide real-time online access to estimated out-of-pocket (OOP) costs, enhance patient engagement and reduce market prices for various procedures. It also helps patients be more aware of their payment responsibility to their provider.  

5. Prioritize Privacy and Security.

Online crime isn’t anything new, but the healthcare industry continues to bear the brunt of data breaches. In this second-most cyber-attacked industry, they occur through a variety of incidents, including stolen devices, hacking, human error and negligence. 

As a healthcare provider, it’s crucial that your organization is committed to data security and privacy. You can start by ensuring you’re up-to-date with all the requirements of the Health Insurance Portability and Accountability (HIPAA) Act, Health Information Trust Alliance (HITRUST) Service Organization Control (SOC), the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Payment Card Industry Data Security Standard (PCI-DSS). Train your staff on security measures regularly, and verify that any technology you utilize is HIPAA-compliant and has earned HITRUST Certification status. 

Exceed Patient Expectations for an Optimal Patient Experience

The proliferation of digital health resources has enabled healthcare provider organizations of all sizes—from small medical groups to large hospitals and health systems—to better meet patients’ expectations. One prominent example is telehealth, which assists in remotely delivering healthcare services. Its use skyrocketed during the COVID-19 pandemic and is now employed by almost half of all United States physicians to treat patients. Telehealth enables patients to access care in the comfort and privacy of their own home and avoid a lengthy waiting time in the doctor’s office before their appointment. 

Other popular digital health tools utilized to improve the customer experience are those that allow patients to complete pre-appointment tasks on their smartphone or other mobile devices. In the previously-mentioned Kyruus report, more than 90 percent of respondents express being extremely or very interested in using digital self-service for pre-appointment tasks. 

Used together, these digital health tools offer a reliable way for providers to offer a positive first impression, securely communicate effectively and efficiently, personalize care and give patients more accurate insight into what they owe. The result is more satisfied patients—and providers—and a more financially and operationally sustainable practice. 

Find out how the HIPAA-compliant and HITRUST-certified Kyruus Health care access platform helps deliver a more consistent, tailored and delightful patient experience across all touchpoints.

The post How to Improve the Patient Experience in Healthcare appeared first on Kyruus Health.

Ensuring accurate provider data and appointment availability across various channels, including health plan sites and search engines, can improve provider’s broader digital presence and facilitate direct scheduling from these platforms. 

Understanding the Impact of Patient Preferences on New Patient Acquisition

A majority of today’s patients prefer researching online to select healthcare providers. Recent research has found that not only do 70% of patients rely on the internet when searching for care, but over 50% actually access three or more different online resources before they make a selection. 

Patients trust the internet almost as much as personal recommendations from friends or family members. When selecting healthcare options, key factors such as cost, quality, and convenience play a crucial role in their decision-making process. The ease of accessing comprehensive and transparent information online allows patients to compare services, read reviews, and evaluate the credentials of healthcare providers. Organizations must understand that if they are looking to effectively capture new patients, they must prioritize their digital presence.

Step 1: Centralize and Optimize Provider and Location Data to Ensure Accuracy

Provider data is stored across various platforms within a health system or hospital, including spreadsheets, credentialing systems, and electronic health records (EHRs), among others. Managing this data can be quite burdensome and time-intensive, particularly due to the need for regular updates and the involvement of numerous users. 

Centralizing provider data is essential for maintaining its accuracy and consistency not only across multiple access points within the organization, but also across digital platforms, which is vital for guiding patients to the right care. 

To optimize provider data and help consumers find a care provider that is best suited for their needs, it’s essential to curate comprehensive profiles that include key attributes such as accepted insurance, clinical expertise, and appointment availability—all crucial factors for patients making decisions.

Enhancing these profiles with additional details like personalized professional statements, introductory videos, and inclusivity indicators can further assist patients in assessing the patient-provider match. By ensuring this information is up-to-date, easily searchable, and tailored to patients’ priorities, organizations can significantly improve the care matching process.

Such centralization and optimization not only enhances online visibility and improves patient access but also streamlines the patient self-scheduling process. Ultimately, by centralizing provider and location data, healthcare organizations can provide reliable information to patients, thereby improving new patient acquisition and overall engagement.

Step 2: Automate Provider Data Updates Across Digital Platforms

Many organizations have up-to-date information about their providers on their own website, but struggle to manage their digital listings across the web. Consumers are often searching for care on their health plan website or a search engine, and managing information on these sites tends to be an extremely time consuming and manual process. 

By centralizing and optimizing provider and location data, healthcare organizations are empowered to manage listings more seamlessly and push updates live automatically across all digital platforms that are connected to their provider data management system. This reduces manual errors and inconsistencies, ensuring that the information remains accurate and up-to-date while reducing administrative burdens on your team.

The other benefit is that new patient acquisition and engagement also improve. A recent study found that 30% of consumers reported skipping or delaying care in the last year as a direct result of encountering inaccurate provider information. Ensuring that this information is accurate may help to prevent care gaps in the future.

Leverage Online Reviews and Social Media to Attract New Patients

In addition to having accurate information on your providers, organizations should encourage patients to leave positive reviews. These reviews help to attract new patients and build loyalty. Consider implementing systems to request feedback through online surveys or emails and respond to reviews whenever possible to show engagement and care.

Social media is another useful platform for engaging with patients, especially among younger consumers. Recent research has shown that over 25% of younger consumers utilize social media when searching for care. Organizations should consider using it to raise awareness and engage with potential patients. It’s a valuable tool for expanding your reach and improving new patient acquisition.

Step 3: Implement Patient Online Scheduling 

Earlier, we discussed the importance of consumer preferences on care selection. Some factors, such as the availability of patient online scheduling, are so important to patients that they will go as far as to seek care with someone else for access to this option. 

Patient online scheduling allows for a seamless connection with real-time availability that is directly integrated with a healthcare organization’s electronic health record (EHR). This convenience can promote greater patient engagement, increasing the likelihood of a scheduled appointment and thus improving new patient acquisition rates. 

Many organizations have patient self scheduling on their website, but fail to offer this capability in other channels that consumers frequent most often. With health plan websites being the first place that most consumers go when searching for care, it is a natural extension for organizations to offer patient self scheduling on these sites. 

Reach Farther, Grow Faster

Acquiring new patients requires a strategic approach. By prioritizing accurate provider data, ensuring an optimal digital presence across platforms, and embracing patient online scheduling, healthcare providers can effectively boost new patient acquisition. 

The post 3 Steps Organizations Can Take to Boost New Patient Acquisition appeared first on Kyruus Health.

In this blog, we’ll explore the critical importance of provider data management for health plans, the tangible impact it has on their financial health, and the strategies needed to overcome common challenges. By the end, it will be clear that effective provider data management is not just a regulatory obligation but a powerful tool for improving member experience, reducing costs, and driving sustainable growth.

For additional insights, register for our upcoming webinar to hear from industry experts and discover strategies for transforming your provider data management approach.

The Business Impact of Provider Data Management

For health plans, provider data management influences five key areas that directly impact their bottom line:

1. Member Experience
2. Access to Care
3. Regulatory Compliance
4. Provider Network Collaboration
5. Operational Efficiency

Each of these elements plays a vital role in a health plan’s overall success, and all are dependent on the quality of provider data. Let’s examine how accurate provider data influences each of these factors and how it can drive measurable improvements for health plans.

1. Provider Data Management Enhances Member Experience

Members look to their health plans for accurate, timely, and detailed information about healthcare providers. When they search for a provider through their health plan’s website, they expect to find up-to-date details on important factors like practice locations, languages spoken, years of experience, and treatment philosophy. Unfortunately, outdated or inaccurate information is a common problem, leading to frustration and dissatisfaction among members.

A recent survey revealed that 62% of members want more accurate information from their health plans, and this need is even more pronounced among younger generations. 70% of Millennials and 64% of Gen Z members expressed a desire for more detailed provider profiles.

The consequences of poor provider data are significant: members may leave their health plan, seek care outside their network, or delay care altogether. In contrast, providing accurate and comprehensive information builds trust between members and their health plans, encouraging them to stay within the network and take advantage of the care options available to them. This translates into higher retention rates and increased member satisfaction, both of which are critical for financial success.

For instance, health plans that offer enhanced provider profiles have reported a 114% increase in member interactions compared to those with non-enhanced profiles. This demonstrates the powerful impact that well-managed provider data can have on member engagement.

2. Provider Data Management Improves Access to Care

Accurate provider data doesn’t just improve member experience—it also plays a critical role in ensuring that members can access in-network care. When provider directories contain outdated or incorrect information, members are more likely to seek care outside of their network, leading to higher out-of-network claims and increased healthcare costs for both the plan and the member.

In fact, 18% of inpatient admissions and 8% of outpatient services involve an out-of-network provider claim, each adding an average of $350 in costs per encounter. Even more concerning, 70% of members who faced unaffordable out-of-network medical bills were unaware that their provider was out-of-network until after receiving care.

By investing in accurate, up-to-date provider data, health plans can help members avoid these costly surprises. Additionally, integrating features like online appointment scheduling, which relies on accurate provider data, allows members to easily book in-network care, further reducing the likelihood of out-of-network claims.

3. Provider Data Management Ensures Regulatory Compliance

The regulatory landscape surrounding provider data management has become increasingly stringent in recent years. Legislation such as the No Surprises Act and the proposed REAL Health Providers Act requires health plans to verify the accuracy of their provider directories regularly and remove any outdated or incorrect information.

Failure to comply with these regulations can result in significant penalties. For example, health plans must now verify provider data quarterly and correct discrepancies within two days. Under the proposed REAL Health Providers Act, health plans must remove providers who are no longer in-network within five business days. Non-compliance could lead to steep fines and damage the health plan’s reputation.

However, compliance isn’t just about avoiding penalties. Health plans that proactively ensure their provider data is accurate, accessible, and understandable to members are better positioned to build trust and foster positive member experiences. By going beyond the minimum requirements of the law, health plans can differentiate themselves in a competitive marketplace while also reducing their risk of financial penalties.

4. Provider Data Management Improves Provider Network Collaboration

Collaboration between providers and health plans is essential for maintaining accurate provider directories. Providers rely on health plans to ensure their information is represented accurately, but they often encounter challenges like inconsistent submission requirements and cumbersome processes for updating their details. As a result, only 20% of providers feel confident that their health plan directories accurately represent their facilities and staff.

Health plans can improve this situation by streamlining the process for providers to update their own information. Implementing user-friendly tools and systems for providers to submit updates can significantly improve data accuracy and reduce the administrative burden on both providers and the health plan. By investing in these solutions, health plans can foster stronger relationships with their provider networks, leading to more accurate and comprehensive directories.

5. Provider Data Management Leads to Operational Efficiency

Managing provider data is a resource-intensive process, often requiring substantial time and labor for manual updates. Health plans that rely on outdated or inefficient systems for managing provider information may find themselves constantly struggling to keep up with changes, leading to higher administrative costs and operational inefficiencies.

A centralized data management system, supported by automated workflows, can significantly reduce the burden of manual data updates. Such a system ensures that updates are reflected consistently across all channels, from member-facing directories to internal systems used by customer service agents. This not only improves the accuracy of provider data but also enhances operational efficiency, freeing up resources that can be redirected toward more strategic initiatives.

Key Strategies for Effective Provider Data Management

To successfully manage provider data and realize the benefits outlined above, health plans should consider implementing the following strategies:

• Centralize Provider Data: Establish a centralized data repository to maintain uniformity and accuracy across all channels.
• Regular Verification: Implement regular verification processes to ensure provider information is current and compliant.
• Enhanced Provider Profiles: Offer detailed, up-to-date provider profiles that meet member expectations for comprehensive information.
• Provider-Friendly Tools: Develop tools that allow providers to easily update their own information, ensuring accuracy and reducing administrative burdens.
• Online Scheduling: Integrate online scheduling functionality to improve access to care and reduce out-of-network claims.
• Automated Data Management: Leverage advanced technologies to automate data management processes, enhancing efficiency and reducing costs.

Conclusion: Why Provider Data Management is a Business Imperative

Effective provider data management is no longer a luxury for health plans—it is a necessity. Accurate, timely, and comprehensive provider data drives improvements in member experience, access to care, compliance, provider collaboration, and operational efficiency. Health plans that prioritize provider data management will not only reduce costs and avoid penalties but also position themselves for long-term success by building trust with their members and providers.

By investing in robust provider data management solutions, health plans can unlock the full potential of their provider networks, improve member satisfaction, and drive measurable financial benefits. For those ready to take the next step, Kyruus Health offers innovative provider data management solutions designed to meet the unique needs of health plans and deliver a clear return on investment. Contact us today to learn more.

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To dive deeper into these topics, register for the upcoming webinar hosted by AHIP, “From Data to Action: Transforming Provider Data into Enhanced Member Experiences.” This session will explore real-world applications of advanced provider data management techniques and their impact on health plan operations and member experiences.

The post Provider Data Management: The Key to Health Plan Success appeared first on Kyruus Health.

Table of Contents:

1. What is Provider Data Management
2. Why Health Systems and Hospitals Should Invest in Provider Data Management
   • Reliable Provider Data is Needed to Power Multi-Channel Patient Access Initiatives
   • Facilitating Optimal Patient-Provider Matching Accelerates Demand Conversion
   • Managing Provider Networks Effectively Optimizes Capacity Utilization
   • Centralizing Provider Data Enables Seamless Care Transitions that Boost Patient Retention
   • Driving Operational Efficiencies and Growth by Maximizing Provider Data Utility Across the Organization
3. Why Health Plans Should Invest in Provider Data Management
   • Accurate and Robust Information Drives Member Attainment and Retention
   • Enhancing Provider Data Closes Gaps in Care Access
   • Addressing Data Inaccuracies Ensures Compliance and Reduces Risk of Penalties
   • Building Impactful Partnerships with Providers Relies on Effective Provider Data Management
   • Automating and Streamlining Provider Data Management Addresses Workforce Challenges
4. Accurate Provider Data to Power the Future

Provider data lives in many places within health systems and health plans. There is information in spreadsheets, credentialing systems, EHRs, health plan directories, and many other locations. The maintenance of this information becomes cumbersome and very time-consuming, especially with frequent updates and many users. 

As organizations look to drive digital transformation and take full advantage of new tools, centralized provider data management is critical. This solution resolves many of the data-oriented challenges healthcare organizations face today. Investing in a provider data management strategy offers organizations the ability to power enterprise-wide initiatives for patients, providers, and staff leveraging consistent data across access points—online provider directories, mobile apps, call centers, and more.

What is Provider Data Management?

Provider data is siloed. It often lives in multiple places across individual hospital departments, spreadsheets, and disparate databases. There are usually different stakeholders responsible for provider data accuracy—making it difficult to keep information up to date. When this happens, it often results in a poor consumer experience on an organization’s website. The information patients encounter such as location, or phone number might be wrong, leading to inaccurate provider directories and poor patient-provider matching. 

Provider Data Management is the consolidation of all disparate data into a single source of truth. Once the source of truth is created, business rules can be put into place around the governance and upkeep of the provider data so that it can be properly maintained over time. Organizations may consider establishing role-based authorizations to enable administrators to control what information users can see and edit. It’s even possible to set up approval workflows to ensure proper checks and balances occur.

Why Health Systems and Hospitals Should Invest in Provider Data Management

An investment in a solid provider data management strategy is foundational. Not only does it power the consumer experience on an organization’s website and mobile app, but it can also be leveraged internally for various different use cases. Consider these 5 foundational reasons to invest in provider data management as you make a business case at your organization.

1. Reliable Provider Data is Needed to Power Multi-Channel Patient Access Initiatives

In order to guide patients to the right care, the information that is presented to consumers about your providers, locations, and services must be accurate and consistent across multiple access points. Without a provider data management system in place, information is often out-dated and inaccurate. 

When a patient looks up a provider online and sees that they practice at a particular location, but then calls to make an appointment and learns that they are no longer at that location, it results in a frustrating patient experience. Consumers should have access to the same, accurate provider data regardless of where they are searching for care. Access should be consistent whether it’s on your website, via general internet searches, or a phone call into your organization. Providing this consistent experience to consumers across access points can go a long way in building trust.

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2. Facilitating Optimal Patient-Provider Matching Accelerates Demand Conversion

Organizations must ensure that the provider directories that house profiles are not only accurate, but complete with information that matters most to consumers when making a selection for their care. Attributes like insurance accepted (94%), clinical expertise (89%), and appointment availability (89%) all help convert patients looking to schedule appointments.

Many patients also like to have access to additional provider data. Some additions could be their professional statement, a video, whether they are LGBTQIA+ friendly, and more. This information can be extremely important as they are considering whether or not it will be a good patient-provider match. Given the option, many patients tend to choose providers based on shared traits.

When a provider data management strategy is in place, this information can all be managed in a single location. Provider data that may not have had a true “home” before such as marketing information like a biography, picture, or video, can all be maintained in a more streamlined manner.  

Another key component of optimal patient-provider matching is ensuring that patients can easily search for a provider based on the specialty they need or symptoms they are experiencing. In many cases this includes lay synonyms such as “the sugars” for diabetes or “tennis elbow” for epicondylitis. Being able to layer on a robust clinical taxonomy that includes all of these different terms is a vital component of a well-rounded provider data management strategy.

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3. Managing Provider Networks Effectively Optimizes Capacity Utilization

Given the current state of supply and demand issues in healthcare, it is more important than ever to have a clear view of your entire provider network. Consider leveraging a provider data management solution to help uncover and address gaps in provider types and services. Doing so can help you make strategic decisions about clinical recruiting to strengthen the integrity of your network.

When organizations have a more granular view into their network, they are able to adjust their access models to optimize capacity and improve appointment wait times. This might look something like, routing back to school physicals or flu shots to an APP such as a nurse practitioner or physician assistant instead of a primary care physician. This type of routing enables better management of capacity at an individual provider level, helping to ensure clinicians are not underutilized, overutilized, and/or misutilized.

4. Centralizing Provider Data Enables Seamless Care Transitions that Boost Patient Retention

Oftentimes when patients receive a referral from their physician or office staff, the information they are given is out of date, and the provider to whom they are referred may not be practicing any longer or may have left the organization. Provider data management can help solve this problem, as it can give all staff members accurate, reliable information at their fingertips. 

This can be especially important for referring providers, who may go to an organization’s website to view physician profiles before determining an appropriate referral. It is vital that the information included on these profiles is accurate, so that providers can make the best choice for their patients. 

Leveraging your provider data management system can help ensure a well-rounded view of an organization’s provider base. Having this accurate view will help empower clinical and administrative staff to guide patients during care transitions. Not only will they be able to connect patients to the most appropriate care, but they can do so in-network.

5. Driving Operational Efficiencies and Growth by Maximizing Provider Data Utility Across the Organization

At a time when resources are stretched thin, put your provider data management solution to work for you across the enterprise. This source of truth can be used throughout the organization in a myriad of ways, extending the utility of your provider data to internal assets such as call center operations,  learning management systems, intranet pages, and more. 

Maximizing provider data utility can help alleviate staffing challenges by eliminating the need for constant manual updates in multiple places, freeing staff up to focus on higher value tasks instead.

Having a centralized provider data management strategy is also extremely beneficial for organizations that may be in growth mode, whether it be organically or through M&A. Having a centralized, streamlined way to onboard the data for new physicians allows organizations to get them live on their website with accurate information much sooner then they would be able to otherwise.

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Interested in learning more about provider data management for hospitals and health systems? Download our guide 5 Reasons to Prioritize Provider Data Management.

Why Health Plans Should Invest in Provider Data Management

Similar to hospitals and health systems, a provider data management strategy is essential for health plans to effectively power member experiences and internal processes. Here are five reasons why health plans should invest in provider data management.

1. Accurate and Robust Information Drives Member Attainment and Retention

When members search for healthcare providers online through their health plans, they expect a seamless and efficient process. However, they often encounter numerous obstacles such as outdated or incorrect information and a lack of comprehensive provider details like languages spoken, years in practice, and treatment philosophy. These deficiencies hinder their ability to find providers who align with their specific needs, leading to significant frustration among members.

A recent survey highlights that a vast majority of members desire more accurate and detailed information in provider profiles. Specifically, 62 percent of members are seeking more precise information, while 70 percent of Millennials and 64 percent of Gen Z members want more comprehensive details about providers. Enhancing the quality and accuracy of information provided by health plans can significantly improve member experiences, foster trust, lead to better healthcare outcomes, and increase member retention and acquisition. This improvement in service and information quality can also substantially boost a health plan’s financial performance, with potential gross margins ranging from $753 to $1,982 per attained enrollee.

2. Enhancing Provider Data Closes Gaps in Care Access

Inaccurate or incomplete provider data poses a significant barrier to accessing healthcare. Essential information like a provider’s gender, ethnicity, specialty, and experience is often missing from health plan directories, preventing members from finding a healthcare provider they trust and feel comfortable with. Discrepancies in provider data also result in “ghost networks,” where providers are listed as available but are not actually accessible. When members can’t find the information they need, they often delay or completely avoid seeking necessary care. One in three members have encountered inaccurate information in their health plan’s digital tools and 30 percent subsequently postponed or skipped care. This issue is compounded by the risk of members inadvertently using out-of-network providers, resulting in unexpected medical bills and increased administrative costs for health plans.

Another barrier to care is lack of online scheduling capabilities. Despite a strong desire among 80 percent of members to schedule appointments through their health plan’s website, over half have skipped care because this option was unavailable.

By integrating scheduling features and enhancing the accuracy of provider information, health plans can significantly improve member experiences, increase interactions with provider profiles, and thereby close care gaps.

3. Addressing Data Inaccuracies Ensures Compliance and Reduces Risk of Penalties

Recent regulatory mandates have been implemented to address the issue of poor data quality in health plans, emphasizing the importance of maintaining accurate provider data. For instance, the No Surprises Act requires health plans to verify their provider data quarterly and make necessary updates within two days. Non-compliance can lead to fines of up to $100 per day for each affected member. Additionally, the proposed REAL Health Providers Act aims to further tighten regulations by penalizing health plans for not correcting outdated information or removing providers who are no longer in-network, targeting the elimination of “ghost networks.”

While adhering to these regulations is crucial, the real challenge lies in how the updated information is presented to members. Many C-level executives in health plans recognize that enhancing the member experience is a significant challenge in meeting transparency mandates. For example, although health plans are required to publish machine-readable files with negotiated rates, this information often lacks the necessary context for members, featuring obscure billing codes that provide little value. Therefore, health plans need to go beyond mere compliance; they must ensure that the data is not only accurate but also accessible and understandable to members. This approach will make the information truly impactful, fulfilling more than just regulatory requirements and genuinely improving member satisfaction and trust.

4. Building Impactful Partnerships with Providers Relies on Effective Provider Data Management

Effective collaboration between providers and health plans is crucial for maintaining accurate and comprehensive provider directories. Providers rely on health plan portals to update their information, but they often face challenges such as inconsistent requirements and a cumbersome updating process. As a result, only 20 percent of providers feel confident that health plan directories accurately represent their facilities and staff. This disconnect highlights the need for improved systems and processes to ensure that provider information is both accurate and easy to update.

Almost all hospitals and health plans recognize the value in more detailed and robust information in provider directories. This is underscored by the fact that over a third of healthcare consumers are willing to switch providers for capabilities such as online appointment booking, which require accurate data. By investing in solutions that allow providers to directly and easily manage their profiles, health plans can streamline data maintenance, reduce labor costs, and ensure the accuracy and timeliness of the data. Establishing a centralized data repository can further enhance consistency across different channels, making updates more efficient and reliable.

5. Automating and Streamlining Provider Data Management Addresses Workforce Challenges

Managing provider data efficiently is crucial for health plans to avoid significant drains on resources. By addressing the root causes of inefficient data management and implementing systems that ensure data synchronization, health plans can prevent potential issues in downstream operations. A sophisticated provider data management platform can automate workflows and tasks, which not only saves time and costs, but also avoids the complications of developing such solutions in-house.

The accuracy of provider data across digital channels is essential, yet it’s important to recognize that many members still rely on direct interactions with providers or customer service to obtain healthcare information. Implementing a provider data management solution that offers real-time updates across all touchpoints ensures that everyone from call center agents to care navigators has access to the most current information.

Accurate Provider Data to Power the Future

As organizations look to embark on digital transformation, they will find that first investing in a solid provider data management strategy will help them be successful in the long run. Set your organization up for success with a digital experience that is powered by accurate, up-to-date information.

Learn more about Kyruus Health’s Provider Data Management solutions for health systems and health plans.

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Introduction to Patient Access Challenges

The 2024 Care Access Benchmark Report for Healthcare Organizations delves deep into key areas that healthcare organizations are focused on, including:

• Boosting new patient acquisition and engagement
• Getting people connected to the right care 
• Driving operational efficiency 

The research also highlights the need for improved patient access. The report discusses how important it is to provide consumers the digital experiences that they desire, however, it also stresses the importance of making sure those digital experiences are powered by accurate, enriched data. Doing so will ensure that patients are matched with the best care for both their clinical needs and personal preferences. It’s important to note that doing this will not only boost patient satisfaction, it can also greatly improve operational efficiency. 

Centralized Data to Power Multi-Channel Patient Access

With 52% of consumers consulting three or more online resources when searching for care, centralizing and maintaining accurate provider, service, and location data is crucial. Organizations can use this centralized data to not only power their owned digital experiences, but they can also push that data out to other third-party sites that consumers frequent most, such as health plan websites or Google. This approach not only aids in attracting new patients but also ensures that existing patients have a seamless experience when seeking care, regardless of where they begin their search.

Preventing Care Gaps Through Digital Patient Engagement

The report shows that 63% of people who skipped or delayed care in the last year could not find an appointment that was at either a convenient day, time, or location for them. 48% of those that skipped care even indicated that they would change providers for access to patient online scheduling. These figures highlight the need for healthcare organizations to expand patient access to self scheduling capabilities, whether that means launching it for the first time or adding additional appointment types or specialties, ultimately making it easier for patients to find and book care on their own time.

Expanding the Digital Patient Journey and Promoting Operational Efficiency

Consumers have spoken: they want the ability to perform as many tasks digitally ahead of their appointment as possible. The days of needing to fill out a mountain of paperwork on a clipboard while sitting in the waiting room are over. Allowing these pre-visit tasks to be completed online will not only meet preference for enhanced patient access, but it will greatly improve operational efficiency by allowing your front-office staff members to focus on other, higher-value work.

The post Enhancing Patient Access: Insights from the 2024 Benchmark Report appeared first on Kyruus Health.

The Association of American Medical Colleges projects a shortage of between 10,100 and 19,800 surgeons by 2036. According to the American College of Surgeons, the financial burden of a medical education is a major driver of this problem. They state that this shortage is “a critical component of the crisis in healthcare because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures.”

Making matters worse, the Association of periOperative Registered Nurses (AORN) reports that 20% of the nation’s surgical nurses will reach retirement age in the next five years. And there’s also a shortage of anesthesiologists. The Journal of Medicine, Surgery, and Public Health reports on this shortage and the increasing demand for surgical services, driven in part by the aging population in the U.S.           

Surgery clinics serve a vital purpose; if patients must delay care because no surgical providers are available near them, poor outcomes may result. With increasing demand coupled with increasing provider shortage, how can these clinics find a way to succeed?

Streamline Clinic Functions by Going Digital

Strategically deployed digital solutions that enable real-time data integration, utilize patient-entered data, prioritize digital patient intake, and engage with and educate patients can help reduce some of the burden created by staffing shortages in surgical specialty clinics. Let’s take a deeper dive into these four strategic capabilities: 

1.    Integrate data directly into the EHR in real time data

Surgical providers can improve their decision-making and enhance patient care when patient’s test results and other data are documented in the EHR as soon as that information is available. Patient safety and clinical decision support are also enhanced by access to information from medical devices and retrospective electronic health record (EHR) data.

EHR integration of real-time data helps surgical providers give patients the top-quality care they seek. Clinicians can reduce unnecessary tasks, tests and procedures by accessing comprehensive, current patient data, which also enables better clinical decisions and health outcomes.

2.    Enable patient-entered digital data instead of paper templates

When patients are asked to fill out paper templates at the clinic, it not only takes time but also can result in errors. Patients can make mistakes or leave out critical information because they don’t have access to the details, and manual data entry into software is always prone to error.

When clinics can leverage digital patient-generated health data, they can save time during the patient’s appointment, increase data accuracy, empower the patient, and enable better patient care. For surgical staff, patient-generated health data improves care delivery by enabling them to easily access important information about a patient’s status. 

3.    Transition to digital patient intake

To streamline registration, clinics can employ digital check-in during the patient intake process. The result is rapid retrieval of completed patient forms, insurance verification, and surgical procedure consent forms. Digital check-in frees up front-office staff, and the surgical staff can view a complete and accurate medical history and medication status.

The Healthcare Information and Management Systems Society (HIMSS) reports that digital check-in decreases patient intake time by 20 percent, reducing the burden on the front desk. Digital check-in also helps optimize patient scheduling, reduce waiting room time, and decrease errors during the registration process. The Medical Group Management Association (MGMA) reports that “patient satisfaction often goes hand in hand with practice efficiency.” They discuss several key benefits to digital patient intake:

•   Reduced wait times helps mitigate the number of disruptive patients, a number that increased by 71% in 2021 according to an MGMA Stat poll.
•   When patients self-report from the comfort of home, it helps improve patient-reported outcomes (PROs). This includes important information such as social determinants of health and family history.
•   Payer information and financial responsibility can be identified and verified prior to clinic visits/procedures.
•   Patients spend less time at the clinic and benefit from self-service and convenience.

Because patient expectations have changed, with many aspects of life increasingly managed online, digital check-in meets their need for a consumer-like healthcare experience. In a poll conducted by Chief Healthcare Executive, 61% of poll respondents stated that they want the convenience of Uber or Amazon Prime from their healthcare providers.

4.    Engage with and educate patients using digital tools

Surgical specialty clinics can use digital tools to engage with patients beyond the clinic walls. This can help improve medication adherence and empower patients to monitor their own health. These tools also offer the opportunity to provide education to patients, including promotion of additional patient services that can be presented during the digital check-in workflow.

At Kyruus Health, our cloud-based, HIPAA-compliant patient engagement platform automates and integrates patient access to alleviate administrative bottlenecks, helping deliver a more consistent, tailored and enjoyable patient experience across all touchpoints.

Surgical specialty clinics today are under pressure given increasing demand with no end in sight, combined with a serious shortage of qualified surgeons, surgical nurses, and anesthesiologists. Strategies to leverage technology that ease the burden of clinic management while also providing patients with a streamlined experience can be of significant value.

Schedule a demo with us to learn more!

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