Health plans: Use provider data management to your advantage

Improve patient experience and compliance and lower costs

A mistake in a directory of providers is not only a frustrating experience for patients, it can move a health plan into noncompliance — triggering substantial repercussions. A provider data management (PDM) strategy is important as ongoing healthcare mergers and acquisitions can lead to outdated provider information as well as duplicative, incomplete and even conflicting data. Provider data errors add up to disruptions in provider network efficiency, network management and network adequacy requirements.

Advancements in AI, automation and API-driven platforms can enable payers to manage provider data — elevating patient satisfaction and reducing administrative costs. When selecting a PDM vendor, payers should decide on their implementation direction, focusing on either specific functional areas or a comprehensive PDM platform. Consider operational needs, compliance risks, time to value and scalability. Take a phased approach into account, with diagnostic assessments, pilot programs and benchmarking to identify key improvement areas. Evaluate data management vendors for strategic, cost, technical and operational trade-offs.