Case Study

Leading physician network provider improves data accuracy with PDM, saving nearly $1 million

Industries
Healthcare

Overview

A leading physician network provider saved nearly $1 million, improved data quality, and reduced provider abrasion with HGS’s Provider Data Management (PDM) and credentialing.

Client Background

Access to care that affects Star ratings is a challenge for many payers. One leading physician network provider was looking to reduce costs and improve the quality of their PDM and credentialing solutions.

Business Challenge

As a provider of physician networks, the client was experiencing a high propensity of provider data errors as a result of their agents manually keying in data. The importance of data accuracy drives reduced provider abrasion and potential impacts to Star ratings. As more and more healthcare companies look to improve the integrity of their data, this leading physician network provider sought HGS’s help to increase savings and improve the quality of their PDM solution.

The Solution

To address the client’s key objectives, HGS leveraged the proprietary PDM solution Provider Forward, a workflow management tool featuring automation and bot deployment. The solution is built with a non-invasive automation technology, based on multiple validation rules to ensure clean entry into the master database. This solution helps identify and translate unstructured data into structured data.  The intelligent bots pick up the cleaned data and update the client’s proprietary system, applying appropriate business rules.  The automation includes scrubbing of rosters supported by bots that capture key data for insights. Data collection and verification are performed outside of the client’s core systems. The tool can provide cleaned output files in most industry-standard formats.

HGS has also introduced a well-integrated CRM that uses machine learning to improve the connect ratio and a predictive model algorithm that prioritizes the queue to increase successful data collection. This is supplemented by a network management solution with the provider credentialing people-process-technology firepower.

Results

Today, the client delivers provider data updates and maintenance from HGS sites in Hyderabad and Bangalore. Here are a few results:

  • Achieved $800,000 in annual savings with PDM support
  • Achieved an additional $155,000 in credentialing cost savings, with a 50% reduction in team size
  • Maintained database quality of transactions processed through automation to 99%
  • Increased updates from 50,000 to 90,000 updates/month within six months of implementation
  • Manual steps reduced by 70%, with double processing output- eight transactions per hour
  • Increased productivity with no additional hiring

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