One of the main barriers to healthcare progress is healthcare administration, which has remained relatively stagnant, even as the industry as a whole improves and innovates.
Essential administrative processes such as provider credentialing are still rooted in highly manual tasks that rely on written forms and fax machines, and require contacting each primary source to verify a provider’s licenses and certifications. No matter how many entities—from health plans to government agencies—carry out these verifications, each organization must follow the same labor-intensive and manually completed onboarding process for each new provider in each new jurisdiction before they can see and treat new patients.
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One study estimates that these inefficient, repetitive workflows collectively cost the U.S. healthcare industry over $2.1 billion every year, with health insurers taking the biggest hit.
Such waste and redundancy may have been unavoidable in the past when automated solutions were limited. But today, technological advances—and particularly the rise of the API economy, which allows for secure, easy data sharing between digital platforms—have unlocked the potential for a centralized provider databank, which could serve as a single, seamless source of administrative truth.
Essentially, it’s time to do for provider data what the US healthcare system did for patient data years ago with the emergence of shared EHR and EMR systems. This will ensure health organizations can onboard new providers quickly and confidently to meet patient needs and significantly reduce their administrative burdens, driving greater efficiency and savings across the healthcare industry.
Siloed provider data is undermining U.S. healthcare.
The friction caused by isolated, disconnected provider data and documentation negatively impacts the healthcare industry in a number of ways, including:
- Higher costs: Research has shown that there are twice as many administrative staff as there are clinicians working in U.S. healthcare, and automating administrative processes could save the industry up to $265 billion a year. This is in addition to the direct costs incurred by credentialing teams plus the fees charged by individual institutions to verify provider credentials.
- Lost time: Physicians spend as much as 17% of their working hours tending to administrative tasks instead of treating patients. And administrative teams at hospitals, health plans, and other organizations spend many more hours checking credentials.
- Lost revenue: Manual credentialing processes can take up to 180 days, while medical licensing can take up to 60 days. During this time, a provider cannot see new patients or administer care—missing critical opportunities to generate income.
- Stale data: According to a study from the American Medical Association (AMA), 53% of provider directories were found to be inaccurate. What’s more, between 20% and 30% of directory data typically changes from year to year.
- Slow scaling: Cumbersome licensing and credentialing tasks make it difficult for health organizations to grow their networks quickly and onboard new providers when they’re needed. One recent analysis suggests that these time-consuming processes were to blame for how unprepared the U.S. health system was (and still is) to respond to the crisis of the COVID-19 pandemic.
A centralized provider databank can transform healthcare administration.
Several initiatives have helped to pave the way for a centralized provider databank. For example, the Federation Credentials Verification Service (FCVS) allows physicians and PAs to store key credentials that can then be used to streamline licensing across multiple state medical boards. Washington State’s OneHealthPort system allows provider information to be shared with state-wide healthcare institutions. And the nonprofit CAQH helps manage provider data to facilitate credentialing. But these solutions have been limited to specific processes, roles, specialties, or jurisdictions.
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With a truly universal, nationwide provider databank, every authorized healthcare organization could instantly access the information needed to verify and onboard new providers—no matter their location or area of practice, and without asking anything of the providers themselves.
Through our experience at Certify, we believe that API technology has the ability to bring this vision to life. Powerful APIs can connect to hundreds of primary sources in real-time and return thousands of verified provider data points in a matter of seconds, cutting months-long administrative processes down to minutes.
That level of connectivity enables not only fast, one-click credentialing, but automated network monitoring and pre-filled licensing and enrollment applications. Together, these enhancements can save the healthcare industry (and providers themselves) countless hours and resources.
The bottom line
We’re living in a time when streaming, real-time data powers everything from the movies we watch to the optimized routes we take on our daily commutes. It’s time we demand the same for the data that powers our health system, so we can provide efficient and effective pathways to care while meeting the standards that keep care safe—not to mention saving the industry billions of dollars each year.
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