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Provider Data Life Cycle Transformation

Updated: May 26, 2020

An independent provider network organization was operationally constrained from multiple source systems and manual updates, resulting in data integrity and timeliness. Provider data changes take up to 3 to 6 months to take affect, frustrating the provider, patients, and health plan populations, not to mention the internal teams and IT.

Led Business Transformation to transform the decentralized provider data and operations. Created a new framework for viewing provider data in terms of Provider Data Life Cycle - from intake to life event changes to terminations. Worked with each business functions to determine what good looks like or SLA's. This also helped to baseline where the organization is falling down for prioritization.

Key results included the formation of a new Centralized Provider Data Team by pooling resources across various departments; a Data Governance Team; Redesigned provider data in-take and Credentialing processes from a multi-month, high-friction, "black hole" paper-based process to an electronic process done within minutes or days; and the evaluation and recommendation to a centralized provider data store.


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