US Provider Credentialing, Pain Points and Consultancies
Through extensive research, we were able to identify a few key resources that you may find useful, but these resources act more as a building block for creating a plan to address credentialing pain points than actual blueprints. Due to the nature of such strategies relating directly to consultancies' private business plans, the information could not be found pre-compiled and little could be inferred from tangential information. Further, we were unable to find information specific to the United States because the consultancies that were requested for review are global network firms who have released few country-specific reports to the public.
We used our research databases and resources to search for information regarding provider credentialing, and we also attempted alternative keywords in order to find information that might give us some insight. We searched first for the specific services that each of these companies provides and found that for all accept Accenture, credentialing falls under the Advisory arm of the company. At Accenture, it falls under the Consultancy arm.
We then looked for publications and advisory articles about the industry, but we found little information on this route. We also looked for prominent speakers from these firms, but they provided no information on solutions. After this, we combed each provider's website, but found nothing of use.
We followed these same steps to check competitor firms in both the Advisory and Consultancy arms but found just as little information. These competitors included Grant Thornton, BDO, Mckinsey, BCG, and ATK.
In our final effort, we searched the websites of a few healthcare sites but found no information regarding Consultancy and Advisory solutions.
The information requested essentially adds up to be each company's business plan and strategy. Therefore, it is easy to believe they have not published this information to the public. Since these firms directly compete with each other, the strategies provided to customers are closely guarded outside of that interaction. Some companies have mentioned the pain points of their industries in passing but none that we found elaborated on it in terms of personal strategy.
Another issue we ran into is that all the firms mentioned in the request have global networks. Information and cases specific to the United States are therefore scarce.
When we could not find information regarding Deloitte, KPMG, E&Y, PwC, and Accenture, we moved to other competitors such as Mckinsey, Bain, Strategy&, BCG, ATK, and others, but their solutions to credentialing similarly have not been released.
Unfortunately, the industry of interest is a highly private industry. There is little information available to the public, and none of it directly answers the issue of credentialing.
Due to the lack of freely available information, some of the sources provided are not from the last two years. Nonetheless, we hope you find them useful.
An internal PowerPoint from Deloitte details a few issues concerning credentialing as follows:
1. "Credentialing & Privileging — Inefficient credentialing and privileging processes contribute to duplication of work, delays in the processing of applications, and the reliance on temporary privileges as an overarching solution"
2. "Managed Care & Enrollment — The lack of alignment between payer enrollment and managed care functions has created additional and unnecessary work for the medical staff services, delegated credentialing, and
managed care enrollment departments."
3. "Quality & Risk Management — The lack of standard core processes across all of the entities related to credentialing and privileging has exposed organizations to unnecessary risk."
4. "Provider Engagement — Complex and inefficient processes, non-standard forms, and department customer-service has created significant provider dissatisfaction with the credentialing and privileging process. Providers are routinely asked multiple times for the same information, required to spend significant amounts of time filling out forms, and are generally uninformed about the process and the progress of their credentialing and privileging applications."
5. "Technology — Deficient implementation of the information technology systems (and/or manual processes) used by the medical staff services department has led to duplication of effort, excess costs, and significant staff dissatisfaction."
6. "Staff Engagement — The duplicative process, lack of clarity of roles, and deficient information-technology training resources has created a defeated departmental culture where individuals do not feel they can positively change the status quo. This has resulted in significant staff turnover and decreased staff productivity, further contributing to departmental delays."
On slide 12, there is a suggestive implementation of the "Officer of the Inspector General (OIG) Compliance Program." However, there is no evidence of this program being introduced by Deloitte or evidence the program is directly addressing the issues stated above.
Another piece from Deloitte details, in general terms, a checklist for ensuring a successful partnership with physicians. Specifically, it mentions on page 4 "perform[ing] due diligence" via extending "beyond credentialing and background checks," but it does not give any details on how this actually resolves issues within the credentialing process.
There is also a case study involving the Northern Virginia Healthcare Workforce Alliance that may offer some tangential information to answer your question. The case study was mentioned in PricewaterhouseCoopers' Health Research Institute's article aimed at "healing the healthcare staffing shortage." It gives a succinct (47-page) report on the staffing issues that currently exist in the healthcare industry. On page 24, it specifically references a case study where "providers, businesses, academic institutions, economic development agencies, workforce investment and community leaders" worked together to address issues such as "credentialing and clinical training sites." The details of the study are not included, but the report as a whole may prove useful.
Despite a lack of public information, we were able to identify some key reports published by large consultancies referencing their relationship with credentialing and working with physicians. These may be able to act as a starting point for you to construct your own plan.