Why Provider Data Management Is Critical To Your Patient Engagement Strategy

What happens when you have a bad digital experience with a business or provider? You usually don’t go back. Imagine the type of experience a first-time patient or member has when they visit your website. Usually, they want information, and most often they are looking for a physician or other provider of medical care. Are they able to find what they want? How easily? And are the results accurate and complete?

Results from Cedar’s 2019 U.S. Healthcare Consumer Experience Study finds more than half of healthcare consumers are frustrated over their provider’s lack of digital experiences. The study, which conducted in-depth interviews of more than 1,600 healthcare consumers, also found that 2 in 5 Americans are willing to abandon their providers over poor digital experiences – even though the provider-patient relationship is often considered the hardest to break. Recent research conducted by InterSystems found that increasing patient volumes and managing referrals, while decreasing patient leakage, is viewed by healthcare executives as the biggest challenge facing US provider organizations. This makes a positive digital experience even more important.

The use of search engines to find or research a doctor is only increasing. A survey conducted by Binary Fountain found that consumer usage of search engines to find a doctor increased 60% from 2017 to 2019. While just 38% said they used search engines to find a doctor in 2017, 60% used search engines in 2019.

In a Health Reform Monitoring survey researchers found that healthcare consumers encountered many problems when searching for a new provider. They reported that their health plan’s information on participating providers was outdated. Similarly, provider websites often offered limited information on what health insurance they accepted and whether they were accepting new patients, limiting a consumer’s ability to quickly screen potential providers.

What are some root causes of that bad experience? It might be the user interface or the response time of the interaction, or even frustration over a telehealth visit. Often, it’s simply inaccurate or missing information. Back-office data doesn’t always get a lot of care and feeding, but it is foundational to the digital experience. Provider information is a key example.

Many organizations know they have a problem but are unsure how to look for a solution, or what type of solution might help them. Perhaps they should consider a provider data management strategy.

Key elements of a provider data manage strategy include the following:

• Map your business strategy to your provider data management strategy – are there gaps?
• Create a set of consumer-facing scenarios that require good clean provider information.
• Develop a cross-functional provider data governance working group, to assess the challenges and work toward solutions.
• Identify all the sources of provider data within your organization. What systems do they come from? What data do they include?
• Look for a vendor that can create the single source of truth for your provider data and meet your key consumer scenarios.

Industry analyst Gartner® recently wrote a report that highlights the importance of having a provider data management strategy². According to the report, one of the most important benefits is enabling greater patient engagement and transparency. Patients aren’t part of the data curation and management process, but their experience with a payer or provider — and even their healthcare outcomes — can be adversely impacted by bad data. Just one example: A referral to an out-of-network specialist, like a radiologist, can cost a patient hundreds if not thousands of dollars in unexpected charges. A referral to an out-of-network physician will result in high out-of-pocket costs for the patient, and ultimately impact the patient experience, continuum of care, and patient retention.

In addition to the poor experience, scenarios like the one just mentioned can lead to penalties for both providers and payers under the recently enacted No Surprises Act. This regulation went into effect in January 2022. It includes restrictions on how much providers and facilities can bill individuals in situations where a patient inadvertently receives care from an out-of-network provider or facility based on inaccurate provider directory information. Although there are still details to be worked out, providers and payers will need to determine who picks up the cost.

All-in-all no one wins when you have bad, inaccurate provider information. As a health plan or provider, you need to find a solution that helps you better manage and curate that data, which will lead to:

• Enhanced patient engagement and increased revenue
• Better information to internally manage processes
• Easier compliance with a host of regulatory requirements

InterSystems Provider Directory, a Provider Data Management Solution, can start you on that journey.

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2 - Refreshed 9 October 2022, Published 25 May 2021 – Gartner ID G00745634 - Sachin Dev