The CAQH CEO warns that data from bad providers are delaying care and increasing costs.
According to Sarah Ahahmad, CEO of the Affordable Quality Health Care Commission (CAQH), inaccurate provider data leads to a hidden crisis in the healthcare sector – threatening patients’ access to timely care.
She raised this point in an interview last week at the Reuters Digital Health Conference in Nashville. Ahmad’s organization addresses this challenge by acting as a front-end hub for data collection for healthcare providers nationwide.
She noted that bad provider data could cause real harm. For example, erroneous data related to address, hourly, professional or network status can delay care and cause significant access and logistical problems for patients. Ahmed explained that people may reach the wrong location or find out that the provider will not bring new patients, resulting in missing or delayed care.
She also noted that inaccurate catalog data could cause patients to unconsciously get care from off-network providers, resulting in higher out-of-pocket expenses.
Ahmad noted: “The out-of-pocket costs for patients are obviously likely to be higher, for health insurance companies, due to any contracts with the payer’s contract interest rate with that provider and if they don’t have a network, they usually don’t.
Inaccurate provider information poses financial and operational burdens to payers by forcing resources to be put into data manually by placing resources into data. Additionally, regulators such as CMS may impose fines or sanctions if the catalog is inaccurate, especially if they damage patient access or lead to surprise bills.
She added that nearly every healthcare stakeholder (payers, hospitals, clinics and data companies) is involved or affected by the accuracy of the provider’s data. Despite extensive efforts, the problem is largely due to human error and a lack of precise efforts centered on accurate data input, Ahmed said.
She explained that CAQH collects information from 75-80% of its providers through its central portal and then uses it for credentials, directories, contracts and background checks. Overall, the company’s focus is on improving the front-end design of data collection to make it easier to ensure accuracy and completeness.
Ahmad also pointed out that CAQH combines AI and third-party data at data input points to verify information in real time.
She stressed that solving the data problem of providers requires not only better technology, but also a shared commitment from the entire industry to get the data right.
Photo: Yuichiro Chino, Getty Images
