As seen in Exago: Written by Nicole Hitner
Things change slowly in the healthcare industry, but according to Newport Credentialing VP Technology David Meier, they are changing—and for the better.
Before the Affordable Healthcare Act (ACA) became law in 2010, patients, care provider groups, and insurance companies were in a three-way tug of war over finances, each party trying to get the highest return on its investment. Although the country’s quest for an optimized healthcare system continues, Meier says the tone of the conversation has moved away from competition and toward patient-centered systems such as value-based care, a more holistic alternative to fee-for-service payment models.
“There has been a major shift in the industry as a whole,” says Meier. “Before, these three groups had their own agendas and didn’t really work well together. Now, provider organizations are working to align with patients’ needs in order to keep them healthy and happy.”
This paradigm shift has had a major impact on healthcare information systems. Now, more than ever, federal regulators are enforcing data integrity standards and holding providers and insurers accountable for their records, putting companies like Newport Credentialing at the center of the action.
Newport Credentialing Solutions produces CARE, a cloud-based credentialing and provider enrollment application complete with workflows, analytics, and business intelligence. Medical groups use CARE to manage their relationships with insurers like MVP and UnitedHealth. Because the providers, or doctors, in each group must enroll with each insurer separately, the recordkeeping is extensive. Not only that, but each insurer has its own requirements for when and how often providers need to update their information, as governmental penalties for inaccuracy are passed down through the insurer to the doctors themselves.
“It’s really become more and more important that the data that we’re providing to the health insurance plans is accurate,” says Meier. “And this is where business intelligence really fits into the whole thing.”
According to Meier, modern solutions like CARE find themselves thrust into an ecosystem of disjointed technologies. Although provider groups are continuing to consolidate into larger medical groups, their backend processes and programs are failing to keep pace. As a result, providers often have no way to visualize or even query their data themselves.
In these conditions, even running simple reports is an ordeal. “Let’s say a medical group wants to see all their providers and the locations where those providers are seeing patients,” Meier offers by way of example. “Usually what happens is they have to put in a request to IT, IT has to go into an approval process that then gets slated for work, and then it takes two or three weeks for them to start working on the order. Maybe it’s eight hours worth of effort. The group needs something tomorrow, but they’re not going to get it for a month and a half. And that’s not exaggerating.”
When Newport comes on the scene, its business intelligence capabilities change all this for the client organization. Where before providers were relying on spreadsheets and black boxes, now they are able to access, visualize, and report on their data. Some even elect to use CARE’s ad hoc reporting tool to build custom reports on the fly.
As exciting as this newfound freedom is for provider groups, Meier sees BI’s impact on data management as even more significant. CARE connects to a variety of platforms including billing, HR, privileging, and central verification office systems. In many cases, these systems do not interface with each other, and their manually-entered data is rife with inconsistencies. As the reporting hub and common link between these disjointed systems, CARE often becomes the “source of truth” for provider groups, writing cleansed data to the other systems in the network.
“Although provider data management hasn’t historically been a central tenet of provider enrollment, we realized early on that it needed to be,” Meier explains. “Organizations need to centralize this data somewhere. It can’t be in a hundred different systems throughout the organization, and you can’t filter on a location if you have fifty different ways of spelling it.” BI by its very nature is compelling healthcare organizations to clean up their data practices.
But BI is also helping Newport speed up some of the bureaucratic processes that have been holding healthcare back in the first place. With hard data their fingertips, CARE agents are able to tell medical groups how long it takes them to, for example, complete a step of the enrollment process and flag possible inefficiencies. “It was taking around 45 days for one of our clients to get information back to us,” relates Meier. “We showed them this because we have the data and, in doing so, we cut that down to about 12 days.”
For Meier and the rest of the Newport team, these kinds of victories are ultimately about providing better care. If healthcare 1.0 was about profit, then healthcare 2.0 is, as Meier puts it, about “prioritizing patient health.”
“There are downstream effects for everybody,” he says. “For us, it’s managing data and making sure that provider data is as accurate as possible.”
Exago is the original producer of this publication.