The Client Challenge
A large health plan sought to improve its overall provider data management (PDM) strategy to support growing value-based care, advanced data analytics, and network development. The health plan faced ongoing regulatory pressures, poor data quality audit results, and complaints from providers and members. The existing provider data management was fragmented across functions and seen primarily as a means to pay claims.
THE CONSEQUENCES OF OPERATING WITHOUT AN ENTERPRISE PROVIDER DATA STRATEGY:
- Higher volume of data quality and accuracy issues with a downstream multiplier effect
- Increased manual and duplicative provider network management processes
- Additional time to develop and implement new networks
- Increased member and provider abrasion
Navigating to Next: The Solution
The health plan partnered with Chartis to design a future-state vision that would position provider data as a strategic enabler, while aligning functional areas. Stakeholders across the enterprise—representing more than 40 teams, including the core provider data management team—engaged in discussions to inform existing challenges. Several insights immediately emerged: divisions were executing individual strategies with limited alignment, downstream consumers of provider data had little engagement with the core PDM teams, and there was no unified approach to provider data governance. This led to a lack of ownership, clarity, and consistency in handling provider data. The absence of streamlined PDM processes and an enterprise strategy led to the persistence of numerous manual efforts for managing provider data intake, maintenance, and consumption.
Using a multi-stakeholder engagement approach, a strategic roadmap was designed to develop a single source of truth for high-quality provider data to enable network growth, improve provider engagement, and better meet member needs.
