Case Study

Prioritizing Alignment: How a Health Plan Developed an Enterprise Provider Data Strategy

3 minutes

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. 

Navigating to Next: Key Components

collect and analyze

Collect & Analyze

Gather artifacts and information across all teams that intake or consume provider data

emphasize

Emphasize

Measure impact to consumers of provider data and stress criticality of an enterprise approach

innovate

Innovate

Leverage depth of industry expertise and best practices to advance PDM

optimize

Optimize

Design an enhanced future-state model that encompasses the needs of the enterprise

catalyze

Catalyze

Generate stakeholder alignment on a strategic enterprise roadmap

Client Impact

Developing a comprehensive strategic provider data roadmap with input from multiple functional areas enabled the health plan to achieve alignment and allocate additional funding to begin executing priority initiatives. While PDM initiatives were historically funded in response to audits or regulatory requirements, this was a turning point for the health plan’s leadership to view provider data as a strategic enabler. This effort led to a more proactive, dedicated focus on PDM with increased collaboration between provider network operations management, the enterprise data office, and executive leadership, as well as new prioritization on the quality, accuracy, and agility of provider data.

An enterprise-wide provider data strategy required alignment and a roadmap to ensure successful execution. The health plan was set up for success by developing a strategy based on:

40

teams engaged across the enterprise

23

defined provider data related initiatives associated with 5 program pillars

1

proposed master provider ID across more than 5 systems

How We Are Making Healthcare Better

As high-quality, targeted networks become increasingly important, Chartis is actively working with health plans to position provider data as an enabler for growth, enhanced provider experience, and improved health outcomes for members.

—Bethany Richmond, Director, Chartis

Next Intelligence

An enterprise-wide provider data strategy is critical for health plans because it:
  • Enables proactive management: 
    A strategy supports the definition and prioritization of PDM initiatives to mitigate reactive PDM approaches.
  • Informs network growth
    Better provider data can identify high quality providers to meet member needs and improve health outcomes.
  • Enhances operational capabilities 
    Efficiencies gained internally drive processes impacting provider and member experiences.

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