Friday, March 31, 2017

Pushing Provider Data Management To The Next Level

An Interview with BJC Healthcare’s Christy Treacy, Director, Provider Data Management Center Team 

Article was first Published in Provider Advisor Magazine, Winter 2017

About BJC 

BJC HealthCare is one of the largest nonprofit healthcare organizations in the United States, focused on delivering services to residents primarily in the greater St. Louis, southern Illinois, and mid-Missouri regions. With net revenues of $4.3 billion, BJC serves the healthcare needs of urban, suburban, and rural communities and includes 15 hospitals and multiple community health locations, 27,283 employees, and 3,964 physicians.

BJC stands out among large healthcare organizations in that their data management operations are extremely advanced. In this post Christy Treacy and her team provide a deeper look into their data management system, progress they have made by using a master provider database, and goals for continued program growth.

BJC’s Provider Data Management Center

In 2006, BJC began to use Echo as the source of truth for provider data and information. BJC operates a Centralized Verification Organization (CVO) integrated with the PDMC. The CVO does the credentialing and primary source verification for all active physicians and allied health practitioners, and the PDMC processes referring providers, including residents, fellows, and employed nurses. Treacy leads both the CVO and the PDMC, and she and her team manage the provider information for the entire health system and feed dozens of other systems within BJC. The PDMC staff is currently made up of three analysts and one system administrator, and they are currently tracking more than 41,000 active and referring providers.

Tracy and her team started a single database effort in 2006 in order to have a central repository to house all of their providers’ NPI numbers, as the CVO was collecting this information during the credentialing process. After experiencing success for that purpose, they began to move all of the provider information to be stored into the one location rather than in 15 different entities. Some of the services PDMC offers to the BJC Healthcare system include employed nurses, tracking of residents and fellows, verifying referring providers, upkeep of provider records, licensure expirables and more.

One of the big components that the PDMC has implemented with tremendous success is the ability to feed the hundreds of downstream systems throughout the BJC health system. Typically, large organizations create a separate export map for each of the systems they are feeding downstream, but BJC created one master file to export that contains 98 different data fields (i.e. address, licenses, specialty, demographics, id number, facility ID number, etc.). The export goes to BJC’s interface engine, IIG, which does the manipulation and cross walking to get the data in the appropriate format for the downstream system.

Success of Utilizing a Master Provider Database

When reflecting on the successes of the PDMC, Treacy and her team cite the significant reductions in inaccuracies in data, delayed claims, delays of patient care, duplication of provider information, and increased identity protection. Additionally, they emphasize the significant alleviation of manual work since the creation of the PDMC and the Enterprise Export.

Another success that has gradually come with the implementation of the PDMC is a more efficient process for requesting data. Now an IT ticket must be submitted and approved that has the specific details of what data is needed, why, and how often. This process has eliminated a significant portion of phone calls with questions about obtaining information.

One of the biggest improvements has been with provider satisfaction, due to an easier process and having regularly updated provider information. The ever-increasing requests for information signals to the PDMC that the word is being spread among providers that they are available to help. Treacy comments on the drastic improvement with providers, “Sometimes it seems like something small, but if it’s something our providers need and we can help them with it, it’s nice to be a part of the solution.”

Goals for Future Growth – 24/7

In discussing the future of BJC’s PDMC, Treacy explains her vision to continue to grow the provider master management data set and to eventually become a 24/7 operation. She explains that providers often run into trouble after-hours and on the weekends, and she adds, “With so much activity surrounding this whole concept of provider data, with so many different sources needing access to it, and with how often we are going to have to update it to keep it clean and available, we are envisioning we’ll soon be available twenty-four hours a day, seven days a week.”

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