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6 Key Provider Data Management Features Health Plan Leaders Want

Provider Data Management (PDM) solutions have evolved significantly in the last few years. However, many systems still have critical shortcomings that can undermine your health plan’s success. According to health plan leaders, data management tools should ensure data accuracy while delivering updated analytics.

In this article, we highlight areas where many legacy PDM solutions are falling short. Plus, see the 5 key features payer leaders are looking for in a PDM system.

Opportunities for Provider Data Management Solutions

One significant barrier is the lack of comprehensive integration capabilities between disparate platforms and systems. Many existing PDM operations are siloed, and don’t effectively communicate with other technologies—leading to inconsistencies in provider data and impairing effective decision making.

In addition to interoperability, PDM solutions must also be flexible in allowing payers to adapt to shifting healthcare regulations and policies. The healthcare landscape is continuously evolving and requires PDM systems that can swiftly adapt to new regulatory requirements and ensure compliance and patient data protection.

While many solutions claim to offer real-time data updates, the reality is that there is often a lag in the actual implementation of these updates. These delays result in outdated provider information that can impact patient care and operational efficiency. Lastly, user-friendliness and accessibility of PDM solutions remain a concern. Complex interfaces and technical requirements can hinder healthcare providers and staff from utilizing these systems to their full potential, leading to underutilization and inefficiency.

Acknowledging these challenges is essential to pave the way for the next generation of PDM solutions: technologically advanced and empathetic to the end-users' needs, enabling seamless integration, regulatory adaptability, true real-time updates, and intuitive user experiences.

Health plan leaders are looking for a provider data management solution that aligns with their operational and strategic needs. Below are 5 key elements payers want in a PDM system.

Key Elements Health Plans Desire in a Provider Data Management Solution

1.Operational Efficiency:

Health plans aim to streamline their operations through efficient provider data management. They require solutions that collect, consolidate, enrich, and manage provider data from various sources to make informed decisions effectively.

2.Enhanced Analytics:

There is an emphasis on solutions that offer robust analytical capabilities that enable health plans to derive valuable insights from provider data for better decision-making.

3.Data Accuracy and Integrity:

Accuracy and integrity of provider data are paramount. Health plans require systems that ensure data quality, consistency, and reliability to support optimal performance and enhance consumer satisfaction.

4.Real-time Monitoring:

There's a growing need for AI-driven systems that can monitor changes in provider details in real-time. This capability allows health plans to stay updated on any modifications made by healthcare providers promptly.

5. Secure Data Handling:

Data security and privacy are crucial considerations for health plans. They seek provider data management solutions that offer secure data storage, access controls, and adhere to stringent privacy standards to safeguard sensitive information.

6.Quality of Care Improvement:

Ultimately, health plans aim to enhance the quality of care provided to members. They look for solutions that not only ensure accurate provider data but also contribute to improving outcomes and quality metrics like HEDIS.

Health plan leaders are looking for comprehensive PDM solutions that can help them achieve key business goals. This includes enabling operational efficiency, data-driven decision-making, data accuracy and integrity, real-time monitoring, data security, and quality care delivery.

With provider data management through HealthEdge Source™, you can drive operational efficiency and cost savings at your health plan.

Learn more about the value HealthEdge's Provider Data Management (PDM) can deliver. Visit the data sheet.