Welcome to Episode 5 of Let’s Talk about Healthcare, a podcast about the challenges and opportunities, the good and the not so good, and the moments of joy found all over our healthcare system today.
Today, we talk to Tammy Hawes, founder and CEO of Virsys12, a healthcare technology company that works with payers to create efficiency and transparency within provider network data systems and processes. We discuss changing market expectations, the significant opportunities to create process efficiencies, and how better provider data systems can lead to happier members, providers, and employees.
Cloud Based Solutions in Healthcare
Local solutions and spreadsheets in Sharepoint just aren’t enough to keep healthcare companies operating competitively anymore. “The expectation around healthcare data has shifted dramatically in recent years. Everyone: patients, providers, payers, and stakeholders from credentialing to compliance are expecting and depending on accurate and transparent data.”
But many healthcare organizations are scrambling to keep up. Many processes need to be done in coordination with other departments, yet old siloes prevent organizations from moving quickly and making decisions based on the most accurate data. “Scaling networks and moving into value based care require significant automation and interoperability to work effectively.”
Interoperability and Patients
“We really believe that the provider data is at the core of members getting great service. That boils down to knowing who is in the network, and it influences pricing and quality transparency for members. There’s nothing more frustrating to patients than finding a provider they think is in their network, then showing up and realizing they’re not.”
“We find that nobody is trying to prevent patients from knowing these critical answers at all times, they just don’t have the systems in place to make it possible. Back office processes and systems have to be architected to support real time data access for patients.”
Provider Networks and Compliance
Since compliance issues affect a provider’s eligibility to participate in the network and bill for member care, “there’s no way to build and manage a provider network without making sure that all these providers are in compliance. We know that the exclusion process needs to be done in real time, which is why we built an integration with ProviderTrust’s data, to get our clients that continuously accurate data feed about any potential OIG exclusions within a provider network.”
Learn about our Provider Network Monitoring solution.
