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ONC, CMS to Take Part in Provider Data Accuracy Alliance

ONC, CMS, and others will spend the summer of 2017 developing a roadmap to improve provider data accuracy.

Data Accuracy

Source: Thinkstock

- A multi-stakeholder alliance convened by CAQH will meet to discuss and develop a roadmap for improving provider data accuracy throughout the summer of 2017.

Accurate provider information improves the efficiency of various fundamental processes in healthcare ranging from paying claims to procuring provider directories.

The Provider Data Action Alliance comprises representatives from provider organizations, health information exchanges (HIEs), federal agencies, and health systems.

The group has attracted the likes of ONC, CMS, and Surescripts in particular.

According to CAQH, investments in provider data aggregation and management in the healthcare industry total over $2 billion a year. However, inaccurate information is still common.

A CMS report released in 2017 determined that 45.1 percent of practice locations listed in online provider directories were incorrect.

The Provider Data Action Alliance seeks to mitigate these data errors in an effort to reduce administrative costs and patient frustrations.

The alliance came to fruition during the 2016 Provider Data Summit hosted by CAQH when over 100 industry leaders met to address problems with provider data aggregation and management. Participants of the conference agreed on priorities for improving provider data accuracy and decided more industry collaboration was necessary to effectively overcoming certain challenges.

“We are proud to take part in creating a more cohesive healthcare system,” said Chief Administrative Officer of Montefiore’s Care Management Organization Michael Dowling in a recent press release. “When we break down silos in favor of shared approaches, we reduce administrative costs for all stakeholders, including the patients we serve.”

Alliance participants will collaborate to devise strategies to approach challenges inherent to acquiring accurate, timely provider data.

Some challenges that frequently crop up when dealing with provider information include practice location moves, provider retirements, and other life events. When changes occur, providers are often required to inform several health plans and healthcare organizations of each change. This time-consuming, redundant process contributes to their already burdensome administrative duties.

“Creating an operational, statewide capacity to exchange both clinical and administrative data efficiently and securely has made us acutely aware of the great variation and pain points in managing these large data sets,” said Executive Director of the Michigan Health Information Network Shared Services Tim Pletcher. “This is a complex problem, and the work of the Alliance will focus on critical use cases so that we can have the greatest impact in the shortest amount of time.”

Data aggregation requirements vary based on stakeholder and state regulations. As a result, one of the primary goals of the alliance will be to increase provider engagement in maintenance processes.

The alliance will also discuss and develop strategies on ways to create industry-wide data definitions, improve maintenance process and accountability measures, centralize data resources, and foster regulatory alignment.

“Outcomes from the Summit show that diverse organizations are facing similar challenges with provider data. This Alliance is a collaborative effort to develop coordinated strategies and actively begin addressing these challenges,” said Executive Director of CAQH Robin Thomashauer, “We are excited by the energy and engagement of the Alliance participants. Supporting their work reflects our own commitment towards ensuring that provider data better meets the needs of both industry and the patients we serve.”

The expected released date of the provider data accuracy improvement roadmap is set for fall of 2017. 

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