DataSpring Convenes Provider Data Collective to Advance Patient Access, Provider Networks and Care Delivery

Industry leaders establish a common framework for measuring provider directory data quality. 

The Provider Data Collective, convened by DataSpring, powered by CAQH, today announced a new standard to improve the measurement of provider directory data quality for individual clinicians. It is the first solution from the industry-led coalition bringing together health plans, a health professional organization and an accreditation body to tackle challenges no organization can solve alone. The Collective’s mission is to improve the accuracy and reliability of provider information — clinician data that underpins directories, network operations and other essential health care workflows — so patients, clinicians and health plans can rely on information they trust.

Founding organizations of the Collective include Aetna, the American Medical Association, Centene, The Cigna Group, DataSpring, Elevance Health, Horizon Healthcare Services, Inc., Humana, the National Committee for Quality Assurance (NCQA) and UnitedHealth Group.

Provider data — including office locations, new patient acceptance status, health plan acceptance information, clinician education and training, licenses, certifications and other professional credentials — forms the foundation of access to care. Accurate, current data helps patients find in-network care and enables clinicians to participate in networks more efficiently. Inaccurate data creates delays, weakens directory reliability and adds unnecessary administrative burden for clinicians and patients.

Healthcare organizations and government programs use different methodologies to measure provider data quality, resulting in inconsistent measurements and fragmented improvement efforts across the industry. Establishing a common standard will create a clear framework for measuring and improving data quality, helping organizations increase provider data accuracy, reduce administrative inefficiencies and costs, strengthen provider and health plan operations and ultimately ensure patients can access and trust the provider information they need.

In just three months, Collective participants built a measurement framework based on the CMS quality foundation for provider directories and demonstrated the industry’s willingness to move quickly from agreement on the challenge to a practical industry solution.

The Collective is co-chaired by Mike Kane, senior vice president of provider data operations at UnitedHealthcare; Carrie Milby, senior vice president of business operations at Centene; and Dr. Alex Ding, chief medical and public affairs officer at DataSpring. Together, the co-chairs guide the Collective's priorities and help translate industry goals into measurable progress.

"The Provider Data Collective demonstrates what is possible when healthcare organizations focus on solving challenges together," said Sarah Ahmad, chief executive officer at DataSpring. "Health plans, professional associations and industry leaders are aligning around practical solutions that reduce administrative burden across the healthcare system, strengthen patient access to the care they need, and improve the experience for the people who depend on accurate, reliable healthcare information every day."

"Inaccurate provider data can create real barriers across healthcare. Patients struggle to confirm whether a clinician is in-network, providers face delays joining networks and seeing patients, and care teams often lack the reliable information needed to coordinate care," said Tim Kaja, executive vice president of UnitedHealth Group Enterprise Services and board chair of DataSpring. "While CMS established a method to measure provider data accuracy, inconsistent application made it difficult to establish a common baseline for improvement of provider data quality across the industry. The Collective aligned the industry around a shared framework — a more consistent way to measure data quality, identify gaps and track progress."

The data quality measurement standard creates a foundation for tracking and improving provider data quality across the ecosystem. It also allows this industry-led work to inform regulatory activity as policymakers seek to modernize provider data infrastructures. With that foundation in place, the Collective will next focus on other industry challenges, including how accepting-new-patients status is determined, updated and reflected in directories to improve accuracy and patient access.

About DataSpring

DataSpring, powered by CAQH, is the trusted data connector at the core of healthcare, powering the industry with accurate, authorized data from providers and payers to create a more connected ecosystem for all. For more than 25 years, the organization has supported the industry with the largest and most complete healthcare data foundation in the U.S. By improving how essential information moves across the system, DataSpring helps healthcare operate more efficiently and deliver better experiences and outcomes for providers, payers and patients. Learn more at DataSpring.com.

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