Hello, everyone. This is Erica Spice Mason with the Becker Health care podcast. Thank you so much for tuning in. I'm thrilled to have the chance to sit down today with Par, Sas, the senior Director of product management for Health edge. Today, we're going to dive into operational efficiency and provider data management for Health plans. Part, it's a pleasure to have you on the podcast today, just to give our listeners a
little bit more context. I was wondering if you wanted to share a little bit more about yourself, your role, your organization, whatever feels top of mind for you. Thank you, everyone. It's a great pleasure to be here. And I've been bit heritage for, little over 9 years, and I've probably worked in the bigger space. During my time here at Health. I've actually worked on
launching multiple products. And 1 of, my most exciting product launch is the development of our new provider data management platform, we've taken it from concept to reality. Thank you for having me on, ma'am. Actually looking forward to sharing more about our provided data management product and the, impact we aim to make in the health industry. No. Wonderful. Thanks, Par, and we're excited to
have you here. Especially to shed some light on a topic that I think every member of the healthcare C suite is interested right now, and that's driving operational efficiency. We know this is a key driver in many payer organizations, growth and innovation strategies in 20 24. So considering all of this, can you share with us the role of provider data management here? Absolutely. When it comes to the, provider data, operational efficiency, it does play, a very crucial role within health plans.
The first thing to understand is that, the provider data in itself is is very white. And it becomes all the more important for organizations to actually manage. They have provider data across different platforms forms. Let's see that, accurate and up to date provider data is essential for streamlining all of the business operations.
And when it comes to the health plans, they heavily rely on provider information so that they can reduce their claims processing and payment errors, which could actually lead to a much faster and accurate reimbursement. This not only save time, but it also improves relationships for the health plans, with their, provider community provided data management also helps in, enhancing experience.
Members rely heavily on the provider directories that the health plan publish on their websites to locate and identify the in network providers for accessing care. And it is all the more important that these directories need to be accurate and current so that, the Hilton can essentially improve on their member satisfaction and reduce the burden on, the customer service team Provided data, management is also very important when it comes to decision making.
You know, health plans rely on accurate provider information to make very important decisions such as, their network work, analysis, identifying potential caps in coverage and making sure that, they can make a little more informed decision, as they expand and optimize, the network
web. And all of this essentially leads to, improved access in care for their members, and it can also create a much more, cooperative competitive, provider network, moreover now, you know, provider data is also becoming all the more vital for compliance and health plans must meet these regulatory needs related to provided information, which means that, they need to ensure that at any given point, their provider updates, make it into the system and are available for
members so that they can avoid any, potential fines and entities. It's also all the word important to understand that the nature of the provider data, it's extremely dynamic. You have a lot of updates that keep coming in from the, credentialing systems or affiliation or locations.
And, essentially, this needs a very robust data management process, real time updates, and issuing data verification processes are gonna be essential in order to make sure that the health plans can Curate and has, a more accurate and actionable provider data. Would see that, Operational efficiency enhancing it is definitely driving growth. It also foster a lot of innovation for the payer organization.
And, essentially by prioritizing this, it ultimately leads to an improved patient outcome, a much better relationship between the providers and the health plans and overall and operational success. Par. I really appreciate how you outlined all of these areas that contribute to efficiency related to provider data management. So I heard compliance decision making, member experience and satisfaction, faster and accurate reimbursement.
There's a lot of, impact that it sounds like provider data management has on the organization as a whole. So really appreciate how you explained all of those areas. And so I think that leads me to my next question, you know, considering the influence that provider data management has on all of these areas.
What are you seeing as common pain points for health plans when it comes to data management here, And also, are there pain points that you're seeing commonly for Pd tools and platforms as well. Yeah. Absolutely. 1 of the, common pain pinpoint that, health plans face when it comes to the provided data management in itself is, the data
accuracy. Now ensuring that, you know, the provider information is current and is collect, is a constant challenge, given the the frequent changes in provider networks or contract details, or credentialing statuses. Now inaccurate data can actually lead to issues on the downstream side of the business which is, like, you know, claims being appended, or being processed with errors, payment delays and compliance, which another significant
pain point is around the the integration. Now health plans often has data coming in from multiple sources and integrating this data into a single cohesive system, the can actually be very complex. And lack of having an integration can actually result in, data silos, making it difficult, to get a comprehensive view of the provider data that is being floated around within the, ecosystem of the health plan.
In fact, health plans struggle when it comes to the heterogeneous state of formats that are provided by hospitals and other entities. These updates can actually come in in various formats. Especially, it could be structured or it could be also on structured. And this creates a lot of burden on the health plan to actually consume combined and analyze the information effectively coming in from all these different sources.
This in fact adds complexity to their administrative tasks in maintaining and updating the provider data, which I think already is considerably complex in us And many health plans rely on outdated systems. There there maybe sometimes homegrown growth platforms. Or also, you know, tend to manually process, all of these updates, which can end up being extremely time consuming, and Error prone, the accuracy and the completeness of the provider data in itself is, becomes a very complex operation.
And it can actually lead to errors in patient care, billing, and overall poor decision making process in itself.
Pd, with the Pd platform, we are trying to make sure that, you know, we emphasized in addressing all these key areas where of, the platform, focuses a lot and heavily on the data accuracy, seamless integration be it an upstream source that is sending data or it could be a put your downstream business system that means provider data real time, and also adds in a lot more efficiency, and automation so that the overall business process can become administration can be much more efficient
and to also support the comprehensive needs. Yeah. Thanks so much again, Par with you for... For sharing all these insights. And it sounds like there's a lot of room for improvements in Pd platforms as you were just noting And considering all of the challenges that you outlined, especially that piece on... That piece about making sure that data is act... It sounds like a constant challenge. So is this what led Health edge to decide
to develop a Pd tool? I I'd love to know a little bit more of the backstory and hear how the tool came to be and also what differentiates it from others? Absolutely. We decided to build the provider data management system because we recognized a critical need in the health care industry for a more accurate efficient and reliable
provider data. In fact, there were several factors that drove into this, decision making for us we observed that, many of the health plans, including several of our customers were struggling with, the accuracy and the completeness. Of, step provider data.
And, inaccurate or outdated provider information can actually lead to significant issues such as, you know, errors in claim processing, delays and payments, dissatisfaction within the members and the provider community itself, We saw an opportunity for us to address these pain points by creating a solution that interest data, accuracy and reliability.
Secondly, the health care landscape in itself is evolving with increasing demands of, real time data and seamless integration across various systems, the health plans also received provided a, dates in various formats, structured unstructured. And it poses a challenge constantly and trying to consolidate and analyze this information, efficiently. Our solution. Now, the Pd platform is designed
to handle these heterogeneous platforms. In fact, they use our generated Ai low code no code platform, which provides a much more streamlined and cohesive approach, for the provider data management itself. Also, given that, the provider data is very dynamic in nature including, you know, a lot of frequent changes across various upstream systems. This requires, a much more robust and an active management process.
And, Health nuts have homegrown grown systems, and traditional methods active that are outdated, and, they cannot keep up with these changes, which essentially leads to a lot of, inefficiencies and errors. By developing a modern provider data, management platform, we aimed to create a system, capable of handling these, dynamic updates real time and ensuring that the health plans always have access to the boost current and accurate data.
We also recognize recognized the importance of fig and compliance in the healthcare industry.
And, health plans must adhere to, various state and federal regulations regarding provider information our solution is actually designed to support you know, the compliance need reducing the risks of any fines and penalties, our while making sure that, the health times actually meet all the regulatory requirements that are needed I would say health edge, overall objective has always been to enhance operational efficiency
and improve health. Experience and foster innovation within the payer community. And, here we are, and I think Pd checks all of those criteria. It fits right in. Yeah. It's great to hear privacy, and I know we've talked so much about how some of... Payers, perhaps homegrown Pd systems or legacy Pd systems do present the risk of outdated or inaccurate provider data. So to end our conversation, I wanted to just
go a little deeper on that. Can you share with our listeners what those risks are with having outdated or inaccurate provider data? And what would you recommend to to leaders who would really like to mitigate those risks effectively? Awesome. And good question. The potential risks associated with, out outdated or inaccurate provider data or very significant. In fact it of impacts, various aspects of, the health care operations you know, like, claims, processing errors.
When you have inaccurate provider data, this could actually lead to incorrect claim payments or denials. And this can actually cause financial losses for help plans and a lot of, frustrations within the provider community. It also adds the administrative, burden within the provider community by this you know, then they need to do the necessary outreach in order
to resolve, those issues. The payments can also be delayed when you have outdated information, sometimes, you know, the your your payments are all gonna get delayed. And you know, this affects their cash flow and it can also stream the relationship and the trust that the providers will have, you know, between them and the health plan.
It's also now important that health plans must comply with various, regulatory requirements, around provider data, inaccurate provider data and publishing it on the provider directory can lead to non compliance, resulting in, penalties, fines and overall, the repetition damaged force the health plan itself. And members, rely heavily on the provider directory to find an a network providers to access care.
And inaccurate and outdated information can actually lead to difficulties and challenges for finding or locating a provider. And that can also lead to, you know, your member dissatisfaction rates see that also, you know, when it comes to accurate provider data, it's gonna be extremely crucial,
for patients to receive appropriate care. And if you have an outdated information out there, you know, sometimes, this could actually lead to accidental of patients to providers who probably or either, you know, no longer working in a particular location or are no longer part of your network or Sometimes if they have an outdated credentialing, that could also post a challenge. And all of this, I would say leads to a lot of, operational inefficiencies.
And usually, health plans end up having a lot of, administrative staff, and resources to correct correct some of these errors and resolve of these conflicts. And this is overall, it bumps up the administrative costs for, any health plans. And, I, say that, you know, in order to mitigate these just it's gonna be important that and, you know, of the health plans considered a few areas when it comes to, forward thinking.
You need to have a, a provided data platform that would essentially help any health plan, in implementing a process that word offer regular and systematic provider updates, that would ensure that, the provider data remains accurate and current. And these need to have automated feeds almost you know, real me real time if possible so that you know and the hill pads feel confident that at any given point in time, it's the most recent data that is made available for consumption.
As we in bring in provider data, it is also important that health plans have a verification process of the provider data, from multiple sources just so that, you know, you don't heavily trust on 1 single source when it comes to maintaining accuracy and reliability for your provided information.
You're better off, you know, having, an added attest station source or, could be multiple source is that provide your provider data, and to talk at all, you have your roster update So it's gonna be important to have a platform says that would... That can actually curate data from all these different sources, and essentially, you know, create a golden record of provider data that can be consumed for a downstream business process.
Automation is gonna be extremely key. And the real time updates is gonna, significantly reduce the risk of inaccuracies. So it's important that, there is, automation that is in place, so that, you can reduce the manual errors that could any given point in time when it comes to provider data.
And also, they're given that, the provided data can come in in different forms and shapes, you know, trying to standardize that across the board is I would say, is a challenge that cannot be resolved, for that, the only way to overcome that is, by using a platform that can actually adapt to various, to know, to all of the data that is coming in various forms and shapes so that it can make it into the system in a timely fashion for
consumption. And overall, I would say that educating staff on how important it is to maintain provider data is going to be extremely crucial so that if health plan has the opportunity to set high standards for the business. Wonderful. Par appreciate all of the insights today. I appreciate... Especially appreciate what you said about striving for that. I think he called it a golden record of provider data, and all the possibilities we're seeing to achieve that with technology and automation and
platforms that you described. So... Thank you again for outlining really how provider data management is at the intersection of so many issues that are top of mind for payer leaders right now. Really enjoyed having you on the podcast. You so much. I appreciate the opportunity as well. Thank you. Yeah, thank you. And we'd also like to thank Health Ed. For sponsoring today's podcast episode.
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