Provider Credentialing and Data Management

Part
01
of three
Part
01

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.

METHODOLOGY

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.

HELPFUL FINDINGS

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.

CONCLUSION

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.
Part
02
of three
Part
02

US Provider Credentialing, Industry Trends

Credentialing is increasingly becoming automated as more healthcare institutions and providers are opting for electronic-based credentialing in place of the paper-based process. Credentialing is also becoming a critical component in a broader technological architecture that healthcare organizations are using to streamline their operations for greater efficiency. In addition, automated digital credentialing will facilitate easier internal data sharing in the future and more companies should adopt a continuous credentialing process due largely to technological improvements. In the near future, we should see a complete digitization of credentialing processes with the aid of cutting edge technological solutions such as task-specific software and blockchain technology.

Industry websites, industry association media outlets and mainstream media are among the places searched to identify recent trends in provider credentialing. The results returned are rather limited, most likely due to the newness of these technologies. As such, six prominent trends are detailed below.

electronic-based credentialing

One of the biggest trends in credentialing is the migration from paper-based to electronic storage. More providers in the medical and dental industries are storing credentials electronically due to the increased efficiency it brings to their operations. Electronically stored credentials are easy to update, share, and protect. They are also less cumbersome to handle as the data can be stored on a computer or cloud drive, compared to the large amount of resources required in the old paper-based system of credentialing.

credentialing as a driver of efficiency

More providers are beginning to see credentialing as an essential component in a broader technological ecosystem for increased efficiency in the onboarding process including recruitment, privileges, performance reviews and enrollment of staff. By leveraging the power of tech, providers can easily integrate and align credentialing with the central goals of the organization.

Improved Internal Data Sharing

In the future, credentialing will make internal data sharing more efficient. If providers can create and effectively run all their onboarding processes on a single platform, this will provide a robust internal data sharing capability that will greatly enhance productivity.

PERPETUAL CREDENTIALING

Currently, most healthcare providers carry out credentialing every two years. However, providers are beginning to adopt a continuous credentialing in which credentials can be updated once they provide proof. This has been made possible by the digitization and integration of the credentialing process which allows the onboarding continuum to operate on a central technological platform.

Increased Use of Credentialing Software

As healthcare providers continue to adopt new strategies to make the credentialing process more efficient, there is going to be an increase in the use of credentialing software that provides task-specific automation solutions. Healthcare providers can deploy credentialing software to save time, financial resources, and enhance organizational efficiency.

bLOCKCHAIN FOR CREDENTIALING

Some stakeholders believe that blockchain technology can be deployed to make the credentialing process more efficient, although there are fears the technology is too nascent for such uses. Some proposed areas where block chain can be used in credentialing include processing medical claims, coordination of clinical trials, and patient health data exchanges.

Conclusion

Credentialing will continue to experience new trends going forward. In the last 24 months, healthcare providers are increasingly adopting technology in the credentialing process. Also, credentialing is becoming a central player in a unified technological platform for many providers' onboarding processes, and this is going to make internal data sharing more efficient. Additionally, credentialing will become a continuous exercise rather than a two-year cycle activity.
Part
03
of three
Part
03

US Provider Credentialing Data Management, Industry Trends

After thoroughly researching about the US provider credentialing data management market, we found that changes within the industry primarily revolve around three main trends. Such trends include the adoption of blockchain technology to decrease redundancy in repetitive processes, the dramatic increase of essential data requested, and the transition of large health organizations towards master provider data management systems.

BLOCKCHAIN TECHNOLOGY

Hashed Health is a US-based company focused on leveraging blockchain technologies for the healthcare industry. In an article they published in 2017, they stated that the current process of provider credentialing data management is very inefficient. This is primarily due to the very lengthy and redundant process required which also involves granting privileges and enrolling physicians multiple times and in multiple locations on top of confirming very regularly changing provider credentials. Because of this inefficiency, which research shows lead to over 40 percent of provider data being inaccurate, health plan providers face a growing regulatory risk.
Another trend growing in popularity involves the centralization of data stores. However, experts at Hashed Health believe that this solution would prove incompatible with the currently fractured healthcare system in the US. Instead, they believe that a “decentralized transactional layer” which will allow health plans, health systems, and providers to report inconsistencies and share updates about provider data files would be more effective. This will be accomplished by allowing multiple involved parties to exchange and create “tokenized digital data assets” in a more transactional model through blockchain technology.
The growth in popularity of this trend is evident in the recent announcement about the partnership between United Healthcare, Quest Diagnostics, Optum, MultiPlan, and Humana dubbed a 'Blockchain Alliance'. As the title given suggests, five large health organizations in the US have agreed to collaborate in utilizing blockchain technology to improve upon current provider credentialing data management processes.

INCREASING AMOUNT OF DATA REQUESTED

Phynd is a US-based provider of cloud-integrated provider data management solutions for the healthcare industry. A 2017 article they published states that one major contributing factor to the growing difficulty and complexity of provider credentialing data management is the migration of hospitals from healthcare systems to clinically integrated networks, which Internal Medicine News defines as “a collection of health providers, such as physicians, hospitals, and post-acute specialists that join together to improve care and reduce costs.

Because of this change in the market, the number of required provider data continues to drastically increase. Examples of information required to meet these new demands include the travel methods of a provider, business hours, picture, languages spoken, employment relationships, charity participation, and even publications. Adding to the challenges brought by this trend are findings published by Wall Street Journal which suggests that provider data changes by as much as 2.4 percent every month, rising to 30 percent every year.

MASTER PROVIDER DATABASE

PreCheck is a US-based company that has been providing investigation services within the healthcare industry such as provider credentialing since 1993. They recently published an article about four key findings from the 2017 Annual Report on Medical Staff Credentialing. The article states that the healthcare credentialing data management industry is currently trending toward implementing master provider databases. An example of a company that recently adopted this trend is BJC Healthcare, which PreCheck states stands out compared to other large healthcare organizations due to how advanced their master provider data management system is.

The growing popularity of this trend is evident in a 2018 article published by the Credentialing Resource Center, an industry database powered by recognized healthcare information provider HCPro. The article states that Rachel Chen, senior data architect of Providence St. Joseph Health Systems (PSJHS)—considered to be the third largest health system in the US—along with senior consultant for master management data Brigitte R. Workman and senior quality and performance engineer Suman Nooney are the winners of the 2018 CRC Symposium Case Study Competition. Their work won due to the fact that it helped bring in new innovations, forge new business partnerships, and conceptualize products which would have previously not been marketable. Implementing a master data management system (MDM) across a health system that spans seven states, effectively interconnects 50 hospitals, more than 1,000 clinics, and over 25,000 practitioners. In addition to this, the article states that the need to use the same electronic medical records system, credentialing software, and other relevant applications was eliminated. As a result, the quality of data from EMR systems, HR systems, and credentialing systems at PSJHS rose from 70 percent to 97 percent.

CONCLUSION

The provider credentialing data management industry in the US is currently trending toward implementing master provider data management systems, adjustments to meet the growing amount of requested essential data, and the incorporation of blockchain technology for more efficient processes and reliable provider information maintenance.
Sources
Sources