3 Provider Data Management Trends to Look for in 2020

It’s here: A new year in provider data management, and symplr’s ready with predictions for what to expect. In summary, look for 2020 to bring a blossoming of developments already on MSPs’ watch lists: APPs’ expanding scopes, more alignment of the credentialing and payer enrollment functions, and yes, blockchain for credentialing is still hanging in there behind the scenes.

Prediction: APPs' practice authority expands as they grow in numbers and specialize

Effect on provider data management: Creates a more acute need to monitor legislation and manage credentialing, privileging, and P&Ps accordingly

Advanced practice professionals (APPs) are individuals other than licensed physicians who provide a medical level of care and/or conduct surgical procedures in the hospital. CMS and The Joint Commission require them to be credentialed and privileged through the medical staff via a process commensurate with that for physicians. APPs are PAs; advanced practice registered nurses (APRNs) including certified registered nurse anesthetists (CRNAs), certified nurse midwives, NPs, clinical nurse specialists; and pharmacists. However, others providing complex care and/or requiring clinical privileges, as defined by the organization and its state/accreditor(s) make the category of APP fluid.

Bills that allow APPs independence or expanded practice are making their way through state legislatures, with about half of U.S. states having adopted expanded scope of practice laws. Physician groups are pushing back, standing their ground on required medical-doctor supervision and co-signatures on charts, according to the American Medical Association. In 39 states, limits remain on the number of PAs a physician can supervise or with whom a physician can collaborate, for example.

However, statistics from the American Association of Nurse Practitioners and the American Association of Physician Assistants exhibit APPs’ growing numbers and clout:

• NPs hold prescriptive authority in all 50 states and practice in all healthcare settings. 
• NPs compose 25% of the U.S. primary care workforce (and +25% in rural and underserved communities). They complete over one billion patient visits annually. 
• The Bureau of Labor Statistics (BLS) predicts a 26% growth rate for NPs in 2018–2028 (vs. 5% average for all occupations).
• Meanwhile PAs number 31,000 throughout the U.S. in all specialties and settings. 
• About 35% of PAs are employed by hospitals, with many of their services delivered in hospital outpatient settings. 
• The BLS predicts a growth rate of 31% for PAs in 2018–2028.

The writing on the wall for credentialing and privileging professionals and medical staff leaders in the current environment of physician shortages and shrinking access to care for all is to prepare to credential and privilege more practitioners already considered APPs. In addition, get ready to credential and privilege others who increasingly provide complex care (e.g., clinical social workers, clinical psychologists, occupational, physical, and/or speech-language therapists). Bylaws, policies and procedures may require updates as a result of the growth in APPs’ scopes.

Prediction: More alignment of the credentialing and payer enrollment

Effect on provider data management: The process of performing each one efficiently will rely on enhanced communication and sharing between the two.

Integration’s occurring in every facet of healthcare, but we’re focused on that which hits closest to home for you: Alignment of credentialing and enrollment functions. Big drivers—resource savings,  mergers and acquisitions, elimination of redundancies for safety and provider satisfaction, establishing one source of truth—make alignment of credentialing and enrollment a top priority for healthcare leaders.

The big-picture “why” is that every organization that delivers healthcare and employs or affiliates with providers is desperately seeking to reduce costs yet maintain or improve quality, just to survive. Scrutiny is banging at the door of the medical staff administrative functions now because some tasks are redundant with those occurring in enrollment or onboarding. Redundancy causes revenue loss.

The good news for MSPs and payer enrollment professionals is that closer alignment of credentialing and enrollment isn’t about preparing the organization to eliminate your role. It’s quite the opposite. You’ll be leading the effort to demonstrate how you (and/or your team) fully comprehend the changes coming and are onboarding to eliminate redundancies and share the fruits of your labor. Skills like researching, parsing and analyzing data for patterns, and high-level decision making can’t be automated. And they require the credentialing and enrollment functions to be in sync.  

If your department is progressive and enjoys close alignment of credentialing and enrollment, tout the accomplishment to leaders as a revenue-saving feat. If there's work to do, start by learning about processes and job descriptions tangential to yours. Where do they overlap? Use the following sample points to start inter- or intra-departmental discovery and discussions about eliminating redundancy and ultimately, achieving integration:

• What departments or functions touch onboarding, credentialing, and enrollment at your organization: CVO, med staff, enrollment, billing, HR, etc.
• Document the list of internal and external electronic means used to gather and manage provider data: vendor credentialing software, billing software, CAQH, PECOS, online integrated applications from a state or other source, a CVO’s/any other delegate’s software.
• Is sharing a database or sharing screens an option in the current state?
• Compare administrative tasks associated with onboarding, enrollment, credentialing—what items are duplicated?
• At what stage of getting a provider onboarded and set up to see patients do the duplicated (or triplicated!) checks or actions occur?
• Is there a reason for the double- or triple occurrences (i.e., will the data initially gathered change over time—from onboarding to privileging—rendering the update necessary)?
• Could integration eliminate any of the following: duplicate background checks, reference checks, interviews done cross-departmentally, or other?
• Document how would the integrated function will:

• Improve data transparency, accountability, and integrity 
• Foster better communication between departments and team members 
• Decrease time to enroll or credential 
• Improve customer (read: provider/payer/patient) satisfaction rates
• Speed time to reimbursement 

Prediction: Don’t bury blockchain yet

Effect on provider data management: None yet, but it’s an area to watch as investments in blockchain for credentialing continue to grow.

Blockchain seems to split the healthcare community into camps of three: It’s the way of the future, it’s overblown, what the heck is it? Regardless, it’s attracting attention and investment dollars. It’s grown enough that Forbes released its Blockchain 50 list of the top companies investing and developing blockchain tools. Becker’s Hospital Review, a publication popular with healthcare industry decision-makers, now offers a weekly blockchain report for healthcare and cites sources predicting that blockchain in healthcare market will be valued at $500 million by 2020, with a compound annual growth rate of 61.4%.

In healthcare, blockchain is being used for asset management, contract management, medical and health records, medication and treatment adherence, clinical trials, medical billing management, personal health records, and pharmacy supply chain.

It’s unclear whether its use for medical credentialing is in test phase or live, but at least one private company is ready to monetize credentialing blockchain functionality. Hashed Health announced its “exchange” called ProCredEx in mid-2019, where members contribute already-verified credentials information for other members to acquire. True to blockchain form, members will create the rules for the data/communication exchanged. Another company, BlocHealth, built a "healthcare professional credential sharing network" powered by a public blockchain. Becker’s stated in late 2019 that BlocHealth raised between $500,000 and $750,000 in funding. The company continues to expand its technology team.

Some of the benefits of blockchain being touted for provider data include:

• Universality of data: Data can’t differ across databases because there’s only one single record.
• Transparency/accuracy: All data/communication can be traced and audited.
• Control: A person can own their own data and choose who to share it with, and when.
• Decentralization: No third-party administrator or single server is needed to be the keeper of the data.

Acceleration of blockchain across healthcare is a surety, including credentialing. But like any other technological advancement, it’ll need to prove its worth. At minimum, it’s a trend worth watching.