In a previous article, we discussed what a Provider 360 approach is and how it can provide health insurance payers with comprehensive, real-time data about their providers in a highly accessible profile view.
By helping payers understand their provider partners more holistically, the Provider 360 approach can improve member experience, drive better healthcare outcomes, and optimize operations in order to protect payers’ bottom lines.
In this article, we’ll be discussing how the Provider 360 approach can actually be integrated into your organization’s data stack, covering how it works, common integration challenges and solutions, and a pair of real-world examples of the approach in action.
How Does the Provider 360 Approach Work in Setup and in Practice?
In order to implement a Provider 360 approach, it is necessary to build or partner with a data platform that integrates key provider data points to create real-time, accurate provider profiles accessible to all relevant teams. Data engineers will need to ensure that data from claims, clinical records, patient surveys, and other relevant sources are collected and integrated into this unified platform.
Once the relevant data has been integrated into the payer’s data platform, all sorts of game-changing possibilities for optimizing payer-provider cooperation emerge:
- Data Analytics and Performance Tracking: Payers can leverage AI and machine learning to analyze provider performance, identify trends, and predict potential risks in care delivery. The payer can then set up regular performance reviews based on the integrated provider data to facilitate better outcomes.
- Collaborative Care and Consistent Feedback: Facilitating collaboration between payers and providers is easier than ever, as performance data is shared in real-time and improvement plans can be jointly created based on the relevant data.
- Provider Education & Support: Payers can now selectively offer providers with the knowledge, tools, and resources to improve care management and meet quality metrics through targeted training sessions, technology solutions, or access to care management resources that address provider-specific gaps.
Common Provider 360 Integration Challenges Have Established Solutions
Naturally, there are challenges that come with implementation, especially given the complex regulations that healthcare organizations face, not to mention the sheer volume and variety of data that such companies deal with on a day to day basis.
However, managing sensitive provider data and complying with regulations like HIPPA can be addressed through secure, encrypted platforms, ensuring full compliance. Meanwhile, ensuring data consistency across multiple systems and sources can be achieved through regular audits, data standardization practices, and investing in robust data management systems.
Provider 360’s Power in Action
Let’s take a look at two examples of organizations who adopted a Provider 360 approach and see tangible improvements to healthcare outcomes.
- Improving Chronic Disease Management: Using the Provider 360 approach to identify high-performing providers for managing diabetes, and incentivizing collaboration and sharing data, payers can drive networks to be more outcome based. Highmark Health, in partnership with Onduo, saw 92% of participating members with a baseline A1C of 9.0% or greater improve their A1C by an average of 2.7 points upon follow-up. Additionally, members who reported losing weight lost an average of 13.3 pounds, or 5.7% of their starting weight simply by adding a CGM to patients and providing a team approach to managing members with Type II diabetes.
- Reducing Contracting Woes with Provider Data Management: Credentialing and contracting are two important parts of insuring a compliant, properly sized, and adequate provider network. In too many organizations there are filing rooms full of data that could be mined to provide network management teams with information to build upon their current understandings. There are challenges of finding the needed information and managing providers without being overwhelmed by the noise of extraneous data. Hakkoda has developed solutions like Intelligent Agreements, which allows users to actually query in regular language a large set of contracts or credentialing documents. This allows payers to effectively gather a list of providers to target for renewals, contracts, or even training.
In both cases, the payers are empowered to use better, more up-to-date data to drive better healthcare outcomes for their patients, fostering better relationships with providers and improving member experience in the process.
Leverage the Provider 360 Approach and Transform Your Operations with Hakkōda
The improved care quality and patience outcomes, combined with more efficient operations and stronger relationships with providers make a Provider 360 approach a more powerful and effective way of managing provider data.
Organizations who have adopted the approach enjoy a more integrated, efficient, and member-focused healthcare system. By empowering both payers and providers to improve the health of the populations they serve, the Provider 360 approach drives value for everyone.
At Hakkoda, our data experts have deep experience in building powerful, compliant data platforms for healthcare organizations looking to tap into the countless benefits of the modern data stack.
If your healthcare payer organization is ready to build an optimized data approach that improves care while protecting your bottom line, let’s talk today about how Hakkoda can help you overcome integration challenges, adopt a Provider 360 approach, and drive innovative results for your organization.
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