Technological solutions can clean provider data

August 1, 2006

Every year, the poor quality of provider data costs healthcare payers an estimated $26 billion and sabotages their quest for efficient operations. Even the most highly automated plans remain vulnerable to the drain on resources caused by inaccurate provider data, rightly called "the Achilles' heel" of healthcare.

Every year, the poor quality of provider data costs healthcare payers an estimated $26 billion and sabotages their quest for efficient operations. Even the most highly automated plans remain vulnerable to the drain on resources caused by inaccurate provider data, rightly called "the Achilles' heel" of healthcare.

The consequences of bad provider data include:

HARD TO "GET IT RIGHT"

Many solutions to this stubborn problem have been tried-but until now, none have provided the hoped-for results. Manual "scrubbing" of provider files is one of the most common methods payers use to cleanse their data. Scrubbing involves deleting duplicates and fixing other errors in the records, such as removing deceased doctors and updating addresses. However, scrubbing is labor-intensive, time-consuming, and, ultimately, ineffective. As soon as one record is corrected, another often becomes outdated. In addition, people make input errors, and it's difficult for humans to assimilate all sources of information to determine the most accurate and up-to-date record.

Another method is to apply basic technology to match records to other flat files or lists, commonly known as merge/purge systems. Unfortunately, these techniques are basic in nature and have produced less than desirable results. Frequently, the files being matched against are inaccurate or match results are too "loose," creating wrong answers. One manager summed up a company's last foray into a technological fix with the comment: "it blew up our data." The ensuing problems were so intractable that the company had to go back to square one and beyond.

NEW APPROACH

As the healthcare industry continues to become more complex and as NPI (National Provider Identifier) requirements will become mandatory in 2007, a workable, accurate technological fix is mandatory. Since other industries such as the financial services and aerospace industries have found a way to automate and keep accurate records, could the same technology be used in healthcare to fix provider data once and for all?