Hello, everyone. This is Erica Spice Mason with
the Becker Health care podcast.
Thank you so much for tuning in.
I'm thrilled to have the chance to sit
down today with Par, Sas,
the senior Director of product management for Health
edge.
Today, we're going to dive into operational efficiency
and provider data management for Health plans. Part,
it's a pleasure to have you on the
podcast today, just to give our listeners a
little bit more context. I was wondering if
you wanted to share a little bit more
about yourself, your role, your organization,
whatever feels top of mind for you.
Thank you, everyone. It's a great pleasure to
be here.
And
I've been bit heritage for,
little over 9 years, and I've probably worked
in the bigger space.
During my time here at Health. I've actually
worked on
launching multiple products. And 1 of,
my most exciting
product launch is the development of our new
provider data management platform,
we've taken it from concept to reality.
Thank you for having me on, ma'am. Actually
looking forward to sharing more about our provided
data management product and the,
impact we aim to make in the health
industry.
No. Wonderful. Thanks, Par, and we're excited to
have you here. Especially to shed some light
on a topic that I think every member
of the healthcare C suite is interested right
now, and that's driving operational efficiency.
We know this is a key driver in
many payer organizations, growth and innovation strategies in
20 24.
So considering all of this, can you share
with us the role of provider data management
here?
Absolutely.
When it comes to the,
provider data,
operational efficiency, it does play, a very crucial
role within health plans.
The first thing to understand is that, the
provider data
in itself is is very white.
And it becomes all the more important for
organizations to actually manage. They have provider data
across different
platforms forms.
Let's see that,
accurate and up to date provider data is
essential for streamlining all of the business operations.
And when it comes to the health plans,
they heavily rely on provider information so that
they can reduce their claims processing
and
payment errors,
which could actually lead to a much faster
and accurate
reimbursement.
This not only save time, but it also
improves
relationships for the health plans,
with their, provider community
provided data management also helps in, enhancing
experience.
Members rely heavily on the provider directories that
the health plan publish
on their websites to
locate and identify the in network providers
for accessing care. And it is all the
more important that these directories need to be
accurate and current so that,
the Hilton can essentially improve on their member
satisfaction
and reduce the burden on, the customer service
team
Provided data, management is also very important when
it comes to
decision making.
You know, health plans rely on accurate
provider
information to make very important
decisions
such as, their network work, analysis,
identifying potential caps in coverage
and making sure that, they can make a
little more informed
decision, as they expand and optimize, the network
web. And all of this
essentially leads to,
improved access in care for their members,
and it can also create a much more,
cooperative competitive,
provider network,
moreover now, you know, provider
data is also becoming all the more vital
for compliance and health plans
must meet these regulatory needs
related to provided information, which means that,
they need to ensure that at any given
point,
their provider
updates, make it into the system and are
available for
members so that they can avoid any,
potential fines
and
entities.
It's also all the word important to understand
that the nature of the provider data, it's
extremely dynamic. You have a lot of updates
that keep coming in from the,
credentialing systems or
affiliation or
locations.
And, essentially, this needs a very robust data
management process,
real time updates, and issuing data verification processes
are gonna be essential in order to make
sure that the health plans can
Curate and has,
a more accurate and actionable provider data.
Would see that,
Operational
efficiency enhancing it is definitely driving growth. It
also foster a lot of innovation for the
payer
organization.
And,
essentially by prioritizing
this, it ultimately leads to an improved patient
outcome,
a much better
relationship between the providers and the health plans
and
overall and operational success.
Par. I really appreciate how you outlined all
of these areas that contribute to
efficiency
related to provider data management. So I heard
compliance
decision making, member experience and satisfaction,
faster and accurate reimbursement.
There's a lot of,
impact that it sounds like provider data management
has on the organization as a whole. So
really appreciate how you explained all of those
areas.
And so I think that leads me to
my next question,
you know, considering the influence that provider data
management has on all of these areas.
What are you seeing as common pain points
for health plans when it comes to data
management here,
And also, are there pain points that you're
seeing commonly for Pd tools and platforms as
well.
Yeah. Absolutely. 1 of the, common pain pinpoint
that,
health plans face when it comes to the
provided data management
in itself is,
the data
accuracy. Now ensuring that, you know, the provider
information is current and is
collect,
is a constant challenge,
given the the frequent changes in provider networks
or contract details, or credentialing statuses.
Now inaccurate
data can actually lead to issues on the
downstream
side of the business which is, like, you
know, claims being appended, or being processed with
errors,
payment delays and compliance, which
another significant
pain point is around the the integration. Now
health plans often has data coming in from
multiple sources
and
integrating this data into a single
cohesive system, the can actually be very complex.
And lack of having an integration can actually
result in,
data silos, making it difficult,
to get a comprehensive
view of the provider data that is being
floated around within the,
ecosystem of the health plan.
In fact, health plans struggle when it comes
to the heterogeneous state of formats
that are provided by hospitals and other entities.
These updates can actually come in in various
formats.
Especially, it could be structured or it could
be also on structured. And this creates a
lot of burden on the health plan to
actually consume combined and analyze the information effectively
coming in from all these different sources.
This in fact adds complexity to their
administrative tasks in maintaining and updating the provider
data, which I think already is considerably complex
in us
And many health plans rely on
outdated systems. There there maybe sometimes homegrown growth
platforms.
Or also, you know, tend to manually process,
all of these updates,
which can end up being extremely time consuming,
and Error prone,
the accuracy and the completeness of the provider
data in itself is,
becomes a very complex
operation.
And it can actually lead to errors in
patient care, billing,
and overall poor decision making
process in itself.
Pd,
with the Pd platform, we are trying to
make sure that, you know, we emphasized in
addressing all these key areas where of, the
platform,
focuses a lot and heavily on the data
accuracy, seamless
integration be it an upstream source that is
sending data or it could be a put
your downstream
business system that means
provider data real time, and also adds in
a lot more efficiency,
and automation so that the overall business process
can become administration can be much more efficient
and to also support the comprehensive needs.
Yeah. Thanks so much again, Par with you
for... For sharing all these insights. And it
sounds like there's a lot of room for
improvements
in Pd platforms as you were just noting
And considering all of the challenges that you
outlined, especially that piece on... That piece about
making sure that data is act...
It sounds like a constant challenge. So
is this what led Health edge to decide
to develop a Pd tool? I I'd love
to know a little bit more of the
backstory and hear how the tool came to
be and also what differentiates it from others?
Absolutely.
We decided to build the provider data management
system because we recognized a critical need in
the health care industry for a more accurate
efficient and
reliable
provider data. In fact, there were several factors
that drove into this,
decision making for us
we observed that, many of the health plans,
including several of our customers were struggling with,
the accuracy and the completeness.
Of, step provider data.
And,
inaccurate or outdated provider information can actually lead
to significant issues such as,
you know, errors in claim processing, delays and
payments,
dissatisfaction within the members and the provider community
itself, We saw an opportunity
for us to address these pain points by
creating a solution that interest data,
accuracy and reliability.
Secondly, the health care landscape in itself is
evolving
with increasing demands of, real time data and
seamless
integration across various systems,
the health plans also received provided a, dates
in various formats, structured unstructured. And it poses
a challenge constantly and trying to consolidate and
analyze this information,
efficiently.
Our solution. Now, the Pd platform is designed
to handle these heterogeneous platforms. In fact, they
use our generated Ai low code no code
platform,
which
provides a much more streamlined and cohesive approach,
for the provider data management itself.
Also, given that,
the provider data is very dynamic in nature
including, you know, a lot of frequent changes
across various upstream systems.
This requires,
a much more robust and an
active management process.
And, Health nuts have homegrown grown systems,
and traditional methods active that are outdated, and,
they cannot keep up
with these changes,
which essentially leads to a lot of,
inefficiencies and errors.
By developing a modern provider data, management platform,
we aimed to create a system,
capable of handling these,
dynamic updates real time and ensuring that the
health plans always have access to the boost
current and accurate data.
We also recognize recognized the importance of fig
and compliance in the healthcare industry.
And, health plans must adhere to,
various state and federal regulations regarding provider information
our solution is actually designed to support
you know, the compliance need reducing the risks
of any fines and penalties,
our while making sure that, the health times
actually meet all the regulatory
requirements that are needed
I would say health edge, overall objective has
always been to enhance operational efficiency
and improve health. Experience and foster
innovation within the payer community.
And, here we are, and I think Pd
checks all of those criteria.
It fits right in.
Yeah. It's great to hear privacy,
and I know we've talked so much about
how some of...
Payers,
perhaps homegrown
Pd systems or legacy Pd systems do present
the risk of outdated or inaccurate provider data.
So
to end our conversation, I wanted to just
go a little deeper on that. Can you
share with our listeners what those risks are
with having outdated or inaccurate provider data?
And
what would you recommend to to leaders who
would really like to mitigate those risks effectively?
Awesome. And good question.
The
potential risks associated
with,
out outdated or inaccurate provider data or very
significant. In fact it of impacts,
various aspects of,
the health care
operations
you know, like,
claims, processing errors.
When you have inaccurate provider data,
this could actually lead to
incorrect claim payments or denials.
And this can actually cause financial losses for
help plans and a lot of,
frustrations within the provider community.
It also adds the administrative, burden within the
provider community by this you know, then they
need to do the necessary outreach in order
to resolve, those issues. The payments can also
be delayed when you have outdated information, sometimes,
you know, the
your your payments are all gonna get delayed.
And
you know, this affects their cash flow
and it can also stream the
relationship and the trust that the providers
will have,
you know, between them and the health plan.
It's also now important that health plans must
comply
with various,
regulatory requirements,
around provider data,
inaccurate provider data and publishing it on the
provider directory can lead to non compliance,
resulting in,
penalties,
fines and overall, the repetition damaged force the
health plan itself. And members,
rely heavily on the provider directory to find
an a network providers to access care.
And inaccurate and outdated information can actually lead
to difficulties and challenges
for finding or locating a provider.
And that can also lead to, you know,
your member
dissatisfaction rates
see that also, you know,
when it comes to accurate provider data, it's
gonna be extremely crucial,
for patients to receive appropriate care. And if
you have an outdated
information out there,
you know, sometimes, this could actually lead to
accidental
of patients to
providers who probably
or either,
you know, no longer working in a particular
location or
are no longer part of your network or
Sometimes if they have an outdated
credentialing, that could also post a challenge. And
all of this, I would say leads to
a lot of,
operational
inefficiencies.
And
usually, health plans end up having a lot
of,
administrative staff,
and resources to correct correct some of these
errors and resolve of these conflicts.
And this is overall, it bumps up the
administrative costs
for, any health plans.
And, I, say that, you know, in order
to mitigate
these just
it's gonna be important that and, you know,
of the health plans considered a few areas
when it comes to,
forward thinking.
You need to have a, a provided data
platform that would essentially help
any health plan,
in implementing a process that word offer regular
and systematic provider updates,
that would ensure that, the provider data remains
accurate
and current.
And these need to have automated feeds
almost you know, real me real time if
possible so that you know and the hill
pads feel confident
that at any given point in time, it's
the most recent data that is made available
for consumption.
As we in bring in provider data, it
is also important that health plans have
a verification process of the provider data, from
multiple sources just so that, you know, you
don't heavily trust on 1 single source when
it comes to maintaining
accuracy and reliability
for your provided information.
You're better off, you know, having,
an added attest station source or,
could be multiple source is that provide your
provider data, and to talk at all, you
have your roster update So it's gonna be
important to have a platform
says that would... That can actually curate data
from all these different sources,
and essentially,
you know, create a golden record of provider
data
that can be consumed for a downstream business
process.
Automation is gonna be extremely key. And the
real time updates is gonna,
significantly
reduce the risk of
inaccuracies.
So it's important that, there is,
automation that is in place,
so that, you can reduce the
manual errors
that could any given point in time when
it comes to provider data.
And also, they're given that,
the provided data can come in in different
forms and shapes,
you know, trying to standardize that
across the board is
I would say, is a challenge that cannot
be resolved, for that, the only way to
overcome that is, by using a platform that
can actually adapt to various,
to know, to all of the data that
is coming in various forms and shapes so
that it can make it into the system
in a timely fashion for
consumption. And overall, I would say that
educating staff
on how important it is to maintain provider
data is going to be extremely crucial so
that if health plan has the opportunity to
set high standards
for the business.
Wonderful.
Par
appreciate all of the insights today. I appreciate...
Especially appreciate what you said about
striving for that. I think he called it
a golden record of provider data, and
all the possibilities we're seeing to achieve that
with technology and automation and
platforms that you described. So...
Thank you again for outlining really how provider
data management is at the intersection of so
many issues that are top of mind for
payer leaders right now. Really enjoyed having you
on the podcast.
You so much. I appreciate the opportunity as
well. Thank you.
Yeah, thank you. And we'd also like to
thank Health Ed. For sponsoring today's podcast episode.
So listeners, if you'd like to tune into
more podcast from Becker health care, please be
sure to visit our podcast page, at becker
hospital review dot com.