US Provider Credentialing Data Management -Pain Points and Consultancies

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US Provider Credentialing Data Management -Pain Points and Consultancies

After extensive search through Deloitte, KPMG, E&Y, PwC and Accenture's websites, publicly released information, publications and advisory articles, I was not able to determine whether these companies are working to address the pain points associated with provider credentialing data management in the healthcare sector of the United States. Ive determined that the information you requested is not publicly available because of a combination of these big consultancy firms' business strategies and the private nature of the healthcare industry. Although I was able to find information related to the issues in the market, any solutions that the consultancies might provide to the pain points in the data management front are not publicly available as they likely consist of valuable information provided on a case basis by these companies to their corporate clients. Below you will find a deep dive of my research and methodology.


The first step was trying to locate which sub-vertical this service falls under within the consulting companies in question and the specific services they provide. It was revealed that for all these firms (except Accenture) the service forms part of their "Data Management Consulting" domain under the broader "Advisory" arm. However, the advisory related to data is either part of the "Technical Consulting" or the "Digital" arm, especially for Deloitte. There have been no instances which provide a combined insight or case study featuring data-related issues or services except for a Blockchain concept presented both by E&Y and Accenture and detailed further on.

I searched for publications and advisory articles on pain points that the healthcare and data management industries might commonly face, but these are scarce and do not directly refer to credentialing data management. Next, I tried to find any conference or seminar appearances by eminent speakers from the before mentioned consulting firms in the hopes that they would address any work geared towards healthcare credentialing data management of providers and its pain points, but found no such information or any solutions to the problems that might arise in the sector.

Alternatively, speakers from the technical domain have not mentioned anything related to provider credentialing. I then looked into direct Tier-2 competitor advisory firms such as Grant Thornton, BDO as well as the Consulting majors (Mck, BCG, and ATK, among others), all the while focusing my search on their Advisory and Consulting areas. Very limited information addressing credentialing data management issues in US healthcare was found. I moved on to research healthcare sites, which in turn showed no information related to solutions provided by consulting or advisory firms. Lastly, I also failed to locate any paid reports on the topic. 


Although specific information on how and if the main consulting firms are working to address the pain points related to credentialing data management is not available, I have listed some insights that I came across during my research that might be of help. Please note that since information is so limited, a few articles included here are dated beyond the 24-month recency mark.


Deloitte, KPMG, Ernst & Young, PwC, and Accenture provide Consulting and Advisory services in healthcare provider credentialing, but their arm providing data management or data-related advisory is separate. The companies have not spoken much about their role in addressing data management for provider credentialing-related problems or issues. As these are global network firms, US-specific cases are very limited, too.

Since these consultancy firms are in fierce competition with one another, the issues and solutions they find for their clients are not always published openly into the market. Additionally, I was unable to find public focus or statistics on issues related to healthcare data management in the United States, particularly when it comes to provider credentialing advisory. 


There are smaller companies such as CredSimple and Firstsource that specialize in provider credential data management and data processing for the healthcare industry. They provide these services to their clients as a third party. However, evidences of their help in resolving case-based or generic issues arising in the field was not found.


A study titled "Provider Credentialing, Privileging and Enrollment" by Deloitte provides few common issues as the big consultancies list them, indirectly implicating problems that could be resolved by the use of better data management techniques. The study states that complex and inefficient credentialing and privileging processes contribute to duplication of work and delays in the processing of applications. Additionally, it talks about the lack of alignment between payer enrollment and managed care functions, which has created additional and unnecessary work for the medical staff. These complex and inefficient processes result in providers being routinely asked multiple times for the same information, and spend significant amounts of time filing out forms. Overall, the study concludes that deficient implementation of the information technology systems (and/or manual processes) used by medical staff service departments has led to duplication of effort, excess costs, and significant employee dissatisfaction.


As previously mentioned, these firms presented combined insight in data-related issues or services in provider credentialing. A study titled "Blockchain in health: How distributed ledgers can improve provider data management and support interoperability" published on September 2016 by E&Y, addresses credentialing data in healthcare, although it does not focus on pain points linked with provider credentialing data management. This webinar transcript from 2017 addresses the use of Blockchain as a network to handle tasks and store provider data. However, there is no information mentioned related to data management issues.


In this study, global management consulting firm McKinsey addressed how digital approaches can make it easier for payors to credential providers, design networks and improve reporting to providers, employers and brokers. However, the 2016 article misses on marking any issues or within the related matter.


To wrap up, after searching extensively, a direct answer to your question is not publicly available because of strong privacy practices in big consulting firms and the specific nature of the query, which most probably called for private direct case-by-case studies done by these firms for their clients in the healthcare industry. If youd like to continue research on any of the related insights Ive outlined above, just let us know.