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Provider data is currently spread across various applications, and healthcare stakeholders are spending significant amounts of money to maintain and update their databases. However, fragmented databases and manual processes are decreasing efficiency for many organizations. Hence, a poorly managed provider directory can often prevent members from contacting in-network doctors for their health concerns. How can payer organizations navigate provider data challenges to improve provider network performance and simplify member experience?

Today, data is at the center of healthcare. Providers, payers, and healthcare organizations are increasingly concerned about how to efficiently store large amounts of data and use it to extract value for members. Payers seeking to meet business goals and improve health outcomes for their members should consider investing in cloud technology as the healthcare industry continues to move toward value-based care. The cloud is the future of data storage and utilization, and selecting the right technology is the key to achieving optimal results. Data usage can be optimized with cloud-based solutions for data analytics, member engagement, and provider network management, enabling payers to improve plan performance. CXOs at these organizations must realize the true value addition of cloud technology.

Traditionally, the healthcare industry has underutilized technology to improve care delivery. As a result, healthcare data is now siloed between departments and applications, making access to a patient’s longitudinal record complex—if not impossible. And most recently, the COVID-19 pandemic exposed even more limitations of current healthcare IT infrastructure running on legacy technologies.

Did you know that network leakage accounts for 55%-65% of the total lost revenue resulting in a loss for a hospital of approximately $821,000-$971,000 per physician?

Optimizing care procedures to boost patient health outcomes and ROI for health systems Since its inception in the 1960s, Medicaid managed care has now been adopted in various forms by 48 US states, with private insurers (both nonprofit and for-profit) covering an increasing number of beneficiaries. Despite its widespread adoption, there is a need for payment reform with stronger quality monitoring and alignment among states, plans, and providers to enhance value. The Centers for Medicare and Medicaid Services is now moving forward with initiatives that increase providers’ downside risk.

Creating a unified data approach to optimize clinical and financial outcomes for healthcare organizations. Shrinking reimbursements and increasing consumerism have made it critical for healthcare executives to understand and unlock the power of their organizations’ data. Health systems are progressively leveraging their data to eliminate waste, enhance efficiency, and deliver upgraded patient service. All these factors congregate to the chief information officer’s (CIO) desk as information systems departments are tasked with implementing data in a suitable manner to meet new operational requirements.