Bill Christy, SVP and Managing Director of Provider Data Management Solutions at symplr

As healthcare costs continue to rise and workforce shortages reach a critical level, hospitals and health systems must rethink their tech stacks and processes to find success in 2024 and beyond. Provider data management (PDM), a function once relegated to the basement of hospitals, today plays a critical role in driving workforce efficiency, revenue, and patient outcomes. By implementing an end-to-end PDM solution, hospitals and health systems can maximize patients’ and clinical providers’ time and help them deliver quality care to more patients, driving revenue and higher patient satisfaction. 

Managing the complexities of provider data and credentialing

PDM touches all areas of healthcare—from quality, to revenue, to regulatory management—and can be seen as the gateway to healthcare delivery since processes like credentialing and privileging enable providers to deliver the specialized care that patients need. Implementing an end-to-end PDM solution helps both payers and providers navigate the complexities of provider data management from start to finish, including contracting, verification, credentialing, privileging, enrollment, and reporting. PDM solutions also support outreach, search, and scheduling for service providers, and help healthcare organizations maintain compliance. Provider data is stored in a central hub that optimizes data for use in electronic health records, digital front doors, and more.

High-quality PDM on the front end translates to higher-quality care and better outcomes on the back end. With a comprehensive PDM solution, healthcare organizations can achieve continuous data-driven quality improvements to their processes.

PDM drives the healthcare revenue engine

Clinicians are the core of the healthcare system and are the highest-paid resource in the industry, making them a significant revenue driver for hospitals and health systems. When credentialing is delayed, health systems lose out on an average of $9000 per provider per day in potential revenue. With this much revenue on the line, hospitals and health systems must get providers credentialed efficiently while maintaining total accuracy. PDM solutions help health systems significantly cut down on credentialing and privileging time. Optimized credentialing and privileging can help your team achieve quality clinical outcomes—not only improving patients’ lives but also driving maximum reimbursement in the era of value-based care. PDM also drives revenue by improving patient engagement and retention, as patients will be more satisfied with shorter wait times and higher quality of care. An exhaustive provider database enables healthcare organizations to identify key data correlations between privileging and clinical outcomes and reimbursement rates.

Supporting the healthcare workforce through better operations

An end-to-end PDM solution should also be at the forefront of health systems’ game plans to alleviate labor shortages and burnout. Optimized PDM can help hospitals and health systems attract and retain healthcare talent. Time spent with patients is key to providers’ job satisfaction, and providers want to work at hospitals and health systems that can streamline busywork like front-end PDM so that they can spend more time with patients practicing medicine. If a provider knows that they will only get paid after seeing a certain number of patients, they are likely to go to a hospital where high throughput and streamlined credentialing will enable them to reach that number faster. By enabling providers to treat patients more quickly, efficient credentialing and privileging can also take some of the burden off other frontline clinicians who may be burning out with an overwhelming patient load.

Credentialing delays aren’t the only factor that can impact a clinician’s ability to provide direct patient care: inefficient healthcare operations software and high administrative burden can also significantly cut into providers’ time with patients. According to a recent survey of Chief Information Officers (CIOs) and clinicians at top U.S. health systems, an average of 20% more time could be redirected to patient care if healthcare operations software were consolidated. Streamlined PDM reduces the administrative burden on providers and other healthcare professionals, giving them more time back to spend with patients.

PDM a Clear Spending Priority

As healthcare organizations kick off spending priorities for 2024, PDMs have become a strategic priority. Many organizations will focus on key goals such as ameliorating workforce shortages and burnout, improving the consumer experience, maintaining regulatory compliance, and driving revenue. Ensuring an accurate provider directory and credentialing are critical to achieving these goals, as PDM touches every area of healthcare. Healthcare organizations can optimize their PDM by partnering with a Credentials Verification Organization (CVO) because CVOs are uniquely positioned to understand bottlenecks in PDM processes. By making end-to-end PDM a priority, healthcare organizations will improve workforce efficiency and revenue while mitigating risk.

About Bill Christy

Bill Christy is the Senior Vice President and Managing Director of symplr’s Provider Data Management Solution product portfolio. In this role, Bill oversees the product vision, development, and go-to-market strategy to deliver solutions that help payers and providers improve healthcare outcomes. A seasoned healthcare operations leader, Bill previously was Chief Customer Officer at symplr, and he continues to be a strong champion for the customer experience. Bill began his career as a Biomed technician in the U.S. Air Force. After a successful career serving his country, Bill moved on to GE Healthcare, where he spent nearly 19 years holding vital leadership roles, such as Customer Operations Manager and Enterprise Services Director.

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