This week's guest is Martin Dunn, CEO of Gaine Healthcare. Martin frames up the current state of provider data and directory issues quite well with this quote:

"It doesn't matter how much you regulate the docs, It doesn't matter how much you've threatened the docs. It doesn't matter how much you incent the docs to pull this information together for you. If you ask questions that are difficult to answer, difficult to understand, impossible to keep up with because the doctors and the physicians and the provider organizations just don't have the systems in order to give you that information, you're not going to get it."

Sticks Won't Fix Provider Data

So, we can't just beat the doctors into submission (pun intended)? What about SB-137? That law has "teeth" to hold the providers accountable.  Not so fast, says Dunn. The first provision is that payers can withhold payments for providers who don't respond in a timely manner with quality data (Bill Barcellona called this "the Hammer Provision" in episode PD-02). That's nice, but it's probably not a good way to do business nor to build collaborative relationships between providers and health plans. The other provision is that health plans can delist providers with out-of-date data. But, as Dunn points out, then you've got health plans breaking their own network adequacy. It's kind of like cutting off your nose to spite your face.

Using Operationally Validated Provider Data

Our position at The #HCBiz Show! has always been that this provider data exists, but it's all over the place and hard to find. More importantly, you have to find it and capture it without adding new work to the providers' plate. Anyone selling into healthcare knows new work is a non-starter.

So, what can we do? Martin offers us a bit of genius on the matter: "Use the existing, trusted relationships".  He points out that the providers have already self-selected the people they trust to keep track of their most important data.  They've outsourced their credentialing to one vendor, their billing to another, and so on. Once you've identified the provider data you need, grab the provider's list of vendors and find out who's the source of truth for each element. The process dictates where the information is stored. According to Martin, we should:

"Connect into existing business processes; existing trusted relationships. Get back to their system so that we can gather that new information. When we find a conflict we can report it out to the people, who in their normal course of business, would want to resolve that conflict. We didn't find the conflict and add it to someone else's "to-do list". We've used the network to identify things that these organizations want to do anyway."

I like to refer to this as "Operationally Verified Provider Data".  If you can identify a source, where the data absolutely, positively has to be correct in order for them to do their work, then you've found your source of truth. Will it always work? No. Of course not, but you're playing the odds that the billing vendor has the most operational opportunity to find and fix problems with... billing data. That sounds like a good bet to me.

On this episode...

I discuss these key topics in more detail and so much more with Martin Dunn, CEO of Gaine Healthcare, including:

1. Why data quality should be defined as fitness for purpose (and therefore the importance of understanding your purpose).
2. Why you should only trust the contract signatory to interpret the facts.
3. How to use a practices vendor list to build a strategy for provider data collection.
4. The challenge of tracking and balancing provider Full Time Equivalency (FTE) in support of provider directories and network accuracy (a new wrinkle that hadn't yet been discussed in our series).
5. What the future holds for the healthcare industry as it pertains to provider directory and the many efforts and collaborations that are underway to address it.
6. How Gaine Health uses its Sanator product to address these issues. Martin walks us through a few scenarios and use-cases.

This episode turns out to be a key part of our series. I promise you'll learn something new.

Enjoy!

~Don Lee

Check it out on:

http://bit.ly/HCBiz-iTunes 
http://bit.ly/HCBiz-GooglePlay
http://bit.ly/HCBiz-Stitcher

Prefer to read it? It's really long, but here you go!

Download the full transcription as a PDF.

About Martin Dunn

Mr. Martin Dunn is an expert in the field of data management. He has founded several successful companies, on three continents focused on making information actionable for large corporations.

Martin was the co-founder and CEO of Gaine Solutions, the first company to offer Master Data Management Software as a Service (SaaS) with clients across multiple industries. Martin is presently the CEO of Gaine Healthcare which is focused on addressing the critical unmet needs of healthcare delivery organizations.

Previously, Martin was the co-founder and CEO of Delos Technology, the world’s first Enterprise MDM Software provider. Delos merged with Siperian in 2003 before selling to Informatica in what remains, the largest ever acquisition by Informatica.

About Gaine Healthcare

Gaine Healthcare enables interoperability between disparate systems allowing clinical, administrative and analytic systems to exchange information relating to patients, health plan members, health care providers and facilities without the need for complex integration code.

For more information go to www.gainehealthcare.com/about

Gaine created the Sanator Provider Registry, a collaborative platform that enables provider organizations and health plans to exchange provider information in an efficient process that reduces administrative overhead for both parties. Sanator eliminates unnecessary outreach by phone and fax to medical offices and gives providers a trusted platform to collect and distribute information to health plans.

For more information go to www.provider-registry.com

About the Provider Directory Podcast Series

This episode is part of our ongoing Provider Directory series that aims to dissect the issue from all perspectives, including provider, payer, patient, and regulator. Our goal is to help facilitate an expanded national conversation that drives us towards an open, collaborative industry solution.

Check out all our Provider Directory posts and episodes here!

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