Provider credentialing, a source of competitive advantage: How modernizing the process promotes efficiency, growth, and patient safety

Amid challenges like staff shortages, physician burnout and endless administrative tasks, hospitals and health systems still are striving to scale their services and impact. To make improvements that are sustainable and efficient, many are revisiting their provider credentialing processes.

Becker’s Healthcare recently spoke with two credentialing experts from Modio Health — John Bou, chief operating officer and cofounder, and Kirk Heath, MD, president — about how technology is transforming physician credentialing.

Credentialing is critically important but time consuming

Before doctors can practice medicine in hospitals, health systems or ambulatory surgery centers, they must be credentialed. Checking credentials contributes to patient safety by ensuring that providers do not have a history of medical malpractice. Unfortunately, credentialing processes have a reputation for being slow and highly manual. The high levels of administrative burden for physicians also contribute to burnout.

“At every healthcare organization, the credentialing team is the gatekeeper to patient care,” Dr. Heath said. “Credentialing is a multi-step process that’s antiquated, takes forever and is relegated to a back office. There’s no reason why it should take 80 to 120 days to verify data points that have been verified multiple times throughout a provider’s career.”

Faster credentialing improves access to healthcare, as well as the bottom line

Consumerism and commoditization in healthcare are changing the way people use it. Patients today want faster access to care. Yet, many healthcare organizations can’t rapidly increase their supply of medical services because they are throttled by credentialing.

“As physician shortages continue to grow, applying technology to the credentialing process will decrease the time it takes for healthcare organizations to get doctors in front of patients,” Mr. Bou said. “We are big believers that technology is the key to providing consumers what they need, when they need it. Modio’s cutting edge technology has empowered us to expedite the credentialing of providers. In some cases we are seeing turnaround times of less than 20 days when the software, staffing departments, and processes are aligned and optimized.”

Reducing credentialing timeframes also has a positive economic impact on hospitals and health systems. “If you can shrink the standard 80 to 120 days to get providers into a hospital, there’s a significant revenue advantage there,” Dr. Heath said.

Credentialing technology helps healthcare organizations grow

Modio Health uses its technology platform and processes to streamline physician credentialing for clients that include large health tech companies and hospitals, and major sports leagues.

“A lot of hospitals and health systems still use paper, fax, Excel spreadsheets and Post-it notes for credentialing,” Dr. Heath said. “In that environment, you need a team of people because the processes are slow and repetitive.”

With technology and automation, a smaller number of employees can manage credentialing for larger groups of providers. “We go after the source of the data, so when you click a button to verify a physician, 90 percent of the information you need is available immediately,” Mr. Bou said. “The team can confirm that a physician is licensed in a specific state and has specific credentials.”

The right platform and processes enable organizations to scale their provider teams without increasing headcount among support staff. Modio Health’s technology also opens up the possibility for continuous credentialing. “Typically, credentialing is conducted on a one- to three-year cycle,” Dr. Heath said. “Thanks to technology, it’s now possible to automatically check licensure on a regular cadence.”

To transform credentialing with technology, performance management is essential

As organizations modernize their credentialing activities, visibility into those processes ensures that investments in  technology are paying off.

“Prior to choosing a platform or technology, define goals and metrics that you can measure as a baseline,” Mr. Bou said. “Without those, you won’t know whether you are achieving the efficiencies that you expected. As you start to work with a technology provider, monitor metrics to see if you are achieving the anticipated ROI.”

A good credentialing platform provides access to data, as well as internal reporting and analysis capabilities that generate actionable insights. “Organizations need the ability to conduct analyses based on their unique needs. No one knows your organization better than you do,” Mr. Bou said.

Keeping pace with innovation in healthcare

Consumer expectations about healthcare are changing and new entrants to the healthcare market such as Amazon and CVS are pushing legacy healthcare organizations forward. To thrive, hospitals and health systems must blend their vision for the future with innovative technologies.

“In this new world, credentialing remains a critical aspect of providing the quality care that patients expect and need,” Mr. Bou said. “To keep pace with increased demand for services, leading organizations have recognized the credentialing process is a long pole and that technology is an effective way to scale efficiently and effectively.”

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