According to a recent poll, staffing is the most pressing concern for U.S. medical practices in 2023—and for good reason.
The latest estimates show that 85% of hospitals, medical groups, and other health systems across the country are facing dramatic provider shortages, just as they’re confronting higher patient acuity due to the lingering effects of Covid-19 and the growing needs of an aging population. As reported by the American Medical Association, the U.S. could face a shortage of up to 124,000 physicians within 12 years if health organizations don’t act fast. While many began implementing telehealth programs to address gaps at the height of the pandemic, it’s not yet understood how these remote care models will work with complex, state-by-state requirements in the longer term.
Health Benefit Consultants, Share Your Expert Insights in Our Survey
Anshul Rathi Anshul Rathi is the Founder and CEO of CertifyOS, a first-of-it’s-kind provider intelligence platform that delivers frictionless licensing and enrollment, one-click credentialing, and real-time network monitoring. Prior to CertifyOS, Anshul was at Oscar Health where he built the credentialing operations division from the ground up, rightfully earning the “one-man credentialing army” moniker. The […]
Indeed, the main barrier to sufficient staffing and efficient, effective care is the burden imposed by administrative tasks like licensing, enrollment, and credentialing. According to research by McKinsey, most health systems are still bogged down by slow, labor-intensive processes—like verifying provider credentials manually or relying on outdated digital methods like data scraping. The result is that providers who are added to a health system, practice, or network may have to wait several months before they can actually see and treat new patients.
To truly solve provider shortages—and get providers practicing sooner—health systems and plans need to automate these essential processes, so they can scale their provider networks and meet increasing patient demand.
Not only would that help avoid lengthy processing delays, it would remove the hurdles that cause many providers to leave medicine in the first place. Providers have identified excess paperwork as their leading cause of burnout (at almost twice the rate of other factors like poor work-life balance) and reducing administrative workloads is the top strategy they recommend to counter it.
Gaps in the status quo
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The process that many health systems use to credential providers is filled with needless friction, redundancies, and logjams.
Typically, a provider must first fill out an application form and provide detailed information about their education, training, licensing, certifications, affiliations, malpractice history, and so on. Then, the health system must check each piece of information against the primary source, resulting in dozens of independent and isolated verifications.
Image by CertifyOS
This process is repeated for every new provider and every new healthcare facility, and it’s repeated every time a provider is re-credentialed to meet external compliance requirements and internal quality controls.
Add to that complex licensing and enrollment workflows, and the result is an inefficient system where providers spend 20% of their time managing network participation at the expense of actual patient care. Meanwhile, manual administrative tasks make up the largest category (about 30%) of wasteful healthcare spending, or up to $280 billion in annual avoidable costs.
As applications are pending, of course, providers are also unable to see patients in the related health system. That can mean 60 to 90 days, on average, of lost opportunities to administer life-changing treatments and generate essential revenue.
So, how can today’s health systems overcome the challenges of (and maybe even reverse) these unprecedented provider shortages? One way is leveraging a centralized databank with real-time provider intelligence to automate and standardize critical administrative tasks—and take costly, time-consuming paperwork out of the equation.
The promise of centralized provider data
A centralized databank would allow health systems to access accurate provider details in real time. That means, rather than collecting and verifying a provider’s credentials manually and one by one, they could tap into a single source of truth that instantly pulls verified data straight from the source.
Next-level API technology is one proven way to meet this goal. With an API-first platform, a health system, payor, or other organization can input a few fields of provider information, and the API will connect to hundreds of primary sources and return thousands of relevant, verified data points in just a few seconds.
This real-time provider data in turn unlocks a number of automated solutions that can save the healthcare industry substantial time and money—from one-click credentialing to continuous network monitoring to pre-filled licensing and enrollment applications. All in all, an API-powered platform can cut administrative processes that have historically taken months down to a matter of minutes.
In our experience, streamlining enrollment with automated data can save providers around five hours per network application. As the average physician is enrolled in 12 health plans, each stands to save up to 60 hours, which can be rededicated to patient care. Reduced administrative burdens also mean greater incentives to join new networks. We’ve seen roughly a 50% increase in application submissions when health organizations embrace API-powered provider data solutions.
This not only means a more efficient and cost-effective health system, it means lower rates of burnout, higher provider numbers and morale, and higher-quality care that’s more affordable and more accessible.
The bottom line
Using tech-forward solutions to optimize provider data and minimize administrative workloads will not only make the healthcare industry more nimble and productive—it will go a long way toward reversing the provider shortages that are putting today’s health systems at an impasse.
If health organizations adopt API-first technologies and work to build and power a centralized provider databank, patients will be able to receive the care they need when they need it—and providers won’t be left standing idle because of paperwork.
Photo: gremlin, Getty Images
Anshul Rathi is the Founder and CEO of CertifyOS, a first-of-it’s-kind provider intelligence platform that delivers frictionless licensing and enrollment, one-click credentialing, and real-time network monitoring. Prior to CertifyOS, Anshul was at Oscar Health where he built the credentialing operations division from the ground up, rightfully earning the “one-man credentialing army” moniker. The development of the division was key to ensuring compliance and supporting the company as it scaled to new markets. While at Oscar he helped reduce the time it took to contract new doctors in both new and existing markets by 50%. He earned his Bachelor of Engineering at Nagpur University in India, and his Masters of Science at Brown University. He travels frequently between the United States and India.
