Healthcare costs continue to rise each year. According to the 2016 Milliman Medical Index, an employer-sponsored plan for the average family of four costs over $25,000 a year. Across the US healthcare marketplace, healthcare organizations continue to look for ways to reduce medical costs, deliver better care, improve patient experience, and build operational efficiencies.
One of the many challenges of healthcare surrounds managing provider data. Providers have multiple, complex and changing relationships, which leads to frequent changes in their location, insurance participation, and affiliations with health systems. Recent surveys report that roughly 20% of provider data, such as demographics and credentials, changes annually. Health plans, provider organizations, and public health organizations struggle to keep up with this constantly changing provider data, each using valuable resources to update similar records. Furthermore, provider data is collected, but not consistent, across disparate systems in a typical health system or health plan. In fact, on average, 30 to 40 percent of provider records in US health systems have missing or inaccurate information.
Incorrect or incomplete provider information can especially be frustrating when providers are trying to refer their patients to a specialist, or when patients are searching for a new provider and trying to determine which ones accept their insurance. So how do organizations tackle the challenge of providing accurate, complete information to its many stakeholders in an efficient way? The Rhode Island Quality Institute (RIQI) has found a solution.
RIQI is setting a new standard for the nation with its statewide provider directory, a key feature of RIQI’s CurrentCare – Rhode Island’s state health information exchange (HIE). CurrentCare is based on InterSystems HealthShare, a software platform that goes beyond basic information exchange requirements to enable the sharing of enriched information, the integration of analytics, and the building of engaged online communities.
Prior to InterSystems, RIQI used the provider registry that was integrated into their Information exchange platform, which simply consisted of a list of providers and their direct addresses. According to Elaine Fontaine, Director, Data Quality & Analytics, at RIQI, “The initial provider directory felt much like a Yellow Pages for providers. The provider information was only available to the providers using our HIE, and helped facilitate data sharing between them. To implement a valuable service, we needed to build a more robust provider directory solution.” Using HealthShare, RIQI is aggregating and normalizing provider data from multiple sources including integrated delivery networks (IDNs) and their affiliated hospitals and providers, payers, and state health department systems. RIQI then uses HealthShare’s sophisticated matching logic to analyze the data and automatically update provider records, merge records, and identify exceptions that get placed in a workflow queue. From there, the data is validated and the directory is updated to reflect relevant changes.
The benefits of RIQI’s provider directory are numerous. To date, RIQI has validated more than 10,000 records from healthcare organizations across the state. The ability to have a central, “single source of truth” for the state that can be shared with the downstream systems creates operational efficiency to their numerous healthcare stakeholders. Healthcare organizations can focus their resources on delivering value-based care and population health management, rather than keeping their internal provider information up to date. For providers, this level of data accuracy supports seamless transitions of care and provider referrals, and also ensures data consistency across multiple electronic medical records (EMRs) and administrative platforms. For insurers, a single, accurate provider directory reduces waste, improves business processes, and helps them avoid federal penalties for inaccurate provider directory information.
The “single source of truth” reduces duplication throughout the healthcare system in Rhode Island, as it significantly lessens the need for each organization to expend resources to amass virtually the same data in their own silos.
The provider directory also creates the opportunity to enhance value to RIQI’s partners. The soon-to-belaunched public portal will give patients the ability to search for providers, allowing them to find a provider that meets their criteria. As providers have to coordinate care across boundaries – e.g., to make referrals – they need to know things about those doctors, such as their electronic direct address, location and other key data. As Laura Adams, CEO of the RIQI, states, “Much of healthcare is a highly fragmented cottage industry. With the movement to team-based care and payment models that reward value, continuously accurate provider information is essential. A well-developed provider directory can capture information about provider participation in ACOs, help connect care teams, and supply information to patients critical to helping them manage their health.”
The success of Rhode Island’s provider directory has set a national precedent. RIQI was recognized as the leader in patient-centric care by the Office of the National Coordinator for Health Information Technology (ONC) and is praised by its regional stakeholders for its work to advance better care for all citizens of Rhode Island. RIQI also participates in the ONC Healthcare Directory Technology Learning Community.
Looking forward, RIQI is in the process of expanding the directory to include more than 3,500 behavioral health providers. Since the HealthShare platform makes it possible to easily connect with other technology, RIQI plans to add additional data sources in the near future.