Capturing and maintaining accurate provider data is crucial for the success of health plans but remains challenging, with 81% of physician directory entries still showing inconsistencies despite regulatory efforts, as highlighted by a study in the Journal of the American Medical Association.

This infographic highlights the importance of robust provider data management, emphasizing its vital role in five key areas with direct impact on health plans’ bottom line:

• Member experience: driving member growth and retention
• Access to care: reducing out-of-network claims
• Regulatory compliance: reducing the risk of regulatory penalties
• Provider network collaboration: streamlining provider profile enhancements
• Improving operational efficiency: reducing manual data updates

To continue building your business case for provider data management, download Kyruus Health’s Comprehensive Guide.

Provider Data Management: A Key to Health Plan Financial Health

Capturing and maintaining accurate provider data is a critical component of a health plan’s success, yet one that remains a top challenge. Provider information is frequently changing, making the task of maintaining this dynamic data seem daunting. Additionally, data is often fragmented, presenting a continuous challenge in pinpointing and correcting inaccuracies.

This guide explores the various provider data obstacles faced by health plans and presents a compelling business case for robust provider data management, emphasizing its vital role in five key areas with direct impact on health plans’ bottom line:

• Member experience: driving member growth and retention
• Access to care: reducing out-of-network claims
• Regulatory compliance: reducing the risk of regulatory penalties
• Provider network collaboration: streamlining provider profile enhancements
• Improving operational efficiency: reducing manual data updates

Insights and Benchmark Data from Kyruus Health and League with Perspectives from Highmark Health and Blue Cross Blue Shield Nebraska

The digital transformation of healthcare presents a multifaceted challenge, but it is one that health plans must embrace. This guide reveals how innovation, data utilization, and strategic partnerships can elevate digital offerings, attract and retain employers, and empower members to actively manage their health. By implementing these insights and strategies, health plans can unlock new growth opportunities, foster deeper engagement with members, and ultimately shape the future of healthcare delivery.

Key Takeaways:

• Digital transformation is not a one-time project but an ongoing journey.
• Member and employer needs must be at the forefront of all digital initiatives.
• Data is a critical asset that can inform decision-making and drive innovation.
• Partnerships with technology vendors can accelerate innovation and deliver world-class experiences.