“Which provider is the lowest cost, highest quality, and is in my CIN?”
“Which ENT takes this narrow insurance?”
“Does this doctor accept new patients?”
“Does this Orthopaedic Specialist see shoulder issues, or only knees?”
“Is a provider anything that provides care, or is it just physicians?”
Many of us have experienced the above points of frustration, but what can we do about it?
The vast majority of healthcare organizations are plagued with issues stemming from ineffective provider directories. There is no shortage to the problems they cause including 1) inefficient provider selection during scheduling and referral order processing, 2) poor patient and staff satisfaction, 3) lack of trusted raw data and analytics needed to make strategic decisions, and 4) poor network performance. In these uncertain times full of ever-changing national and state policy, along with health organization M&A activity, it is imperative to have a solid foundation that contains a high-performing provider directory.
To design, build, and maintain a provider directory is no easy task. Here are the top 5 challenges we have found to help prepare you on your journey:
1) It’s a moving target …
a) Providers change locations, practices, insurance contracts, appointment preferences, and virtually any other data element except for maybe their NPI (yes, even names change!). Without a system to notify the owner of these changes, it can be daunting to try and keep up with this.
2) No consistent data transfer ...
a) Believe it or not, there are still providers today who are self-proclaimed “paper based” practices, while others only use fax or are not willing to give out an email address. They prefer to use snail mail or a dozen of other less efficient methods for communicating. In order for a directory to work, a directory owner needs to utilize a system that allows for receiving provider data in a variety of ways. Also, to do this manually, in a one-by-one fashion, is not realistic … especially as CINs become bigger and bigger.
3) Figuring out access …
a) Is the plan to have one directory that patients, staff, and providers can access? Will it be available on the web? What is the backend technology to organize and manage it? Who can make changes to it and how? What legalities and policy adherences do you need to consider?
Determining an access strategy will be critical to taking a network approach to a provider directory. Words of caution: settling on a strategy that does not align perfectly with an organization can have major consequences.
4) The cost can be prohibitive …
a) To design, build, and maintain a provider directory can be expensive. Assuming you are designing the directory with existing resources, there would be no additional cost to design one, excluding the opportunity cost. However, the building and maintenance can be significant. The building would require a technology team that has experience integrating multiple data sources, and the process can take 9-16 months on average for only an alpha- or beta-tested product. For maintenance, this can require a small army of staff who are constantly adjusting provider data, removing and adding providers, maintaining up time, auditing for accuracy, and finding/implementing ways to always improve the system.
5) Where to start …
a) One of the biggest and most underrated challenges lies in actually getting started. Healthcare organizations need to determine which colleagues have the most knowledge on their network, access to the current data, and interest in this type of work. There also needs to be a value proposition clearly established so that leadership will support a realistic timeline and budget.
We have compiled this list of challenges and based them on our experience of establishing high-quality provider directories all over the country. Do you agree with this list? What would you change, if anything?
About author:
As Vice President of Client Success, Eric leads Fibroblast's delivery and support systems, among other things. Eric is deeply committed to Fibroblast's mission of ensuring that no patient slips through a crack in the healthcare system, and he is passionate about healthcare innovation and reform. Prior to joining Fibroblast, Eric was a hospital administrator at Northwestern Medicine where he oversaw all surgical services for the Blumh Cardiovascular Institute, which came after several years as an administrator in other large, academic medical centers. Eric graduated from Rush University with his Masters in Health Systems Management, after receiving a BS from the Southern Illinois University in Aviation Management.