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Case Study: Public Employees Health Program - Provider Data Management Enhances Value of Data and Employees Alike

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This summary outlines how the Public Employees Health Program (PEHP), a health plan based in Salt Lake City, Utah, overcame significant operational challenges by implementing the HealthEdge Provider Data Management solution. PEHP, managing a complex landscape of 85,000 practitioners, previously relied on manual, paper-based processes that led to inefficiencies and potential inaccuracies.

By adopting a modern, automated approach to provider data management, PEHP achieved a single source of truth for their data, resulting in substantial cost savings, resource reallocation, and improved compliance.

Key Challenges Addressed

Before implementing the HealthEdge solution, PEHP faced several hurdles common to health plans managing extensive provider networks including, disparate data sources, manual processes, and data integrity risks.

Operational Improvements and Results

The deployment of HealthEdge Provider Data Management delivered immediate and measurable results for PEHP, transforming their operational capabilities:

  1. Resource Reallocation: PEHP successfully reduced the need for manual data entry, reallocating the work of up to five full-time employees to higher-value tasks.
  2. Automated Data Matching: The platform achieved a 99.96% success rate in data migration, intelligently matching and merging records to eliminate manual reconciliation.
  3. Rapid Processing: The entire migration process was completed in just 3.5 hours, a significant reduction from previous timelines.
  4. Enhanced Compliance: Automated updates ensure timely adherence to Consolidated Appropriations Act (CAA) mandates, maintaining an accurate provider directory.
  5. Duplicate Prevention: Advanced trust hierarchies and validation logic now eliminate duplicate records at the source, improving downstream claims processing accuracy.

Conclusion

For health plans seeking to optimize cost management and improve data accuracy, the PEHP case study demonstrates the critical value of advanced provider data management. By automating ingest, validation, and distribution processes, health plans can eliminate inefficiencies, ensure regulatory compliance, and empower employees to focus on strategic initiatives rather than manual data entry.