The Workflow Problem Mirrors the Data Problem
Fragmented data leads to fragmented workflows.
If provider eligibility data is fragmented across departments, it makes sense that the software used to act on it would be fragmented as well. The survey findings reflect that reality.
The same departments that interact with provider eligibility data also rely on workflow software tied to their data sources. Credentialing leads the list at 100%, followed by Data Governance at 99%, IT at 97%, Human Resources at 94%, Billing and Finance at 93%, and Compliance at 91%.
Only 6% of organizations have all departments using the same workflow tools, while 55% report sharing tools across most departments. That means nearly 4 in 10 organizations are operating with meaningful workflow fragmentation across teams that should all depend on the same underlying data.
The platforms most commonly used to integrate provider eligibility data reflect the breadth of the problem. EHRs are used by 100% of respondents. CRMs and revenue cycle management systems each come in at 98%. Denial management and appeals workflows sit at 96%. HRIS platforms are at 92%. What’s significant is that these are not niche tools. They are tools that are essential to the core operational infrastructure and rely on different provider eligibility data to make decisions.
Credentialing
Data Governance
IT
HR
Billing and Finance
Compliance
share across most departments.
VS
of organizations share workflow tools across all departments
Organizations that have fully standardized their workflow tools describe real benefits. They report better cross-team visibility, reduced duplication of effort, and more consistent data management. One executive described it this way: ‘standardized tools allow the organization to enforce uniform data management and enhance overall data.’
Respondents who haven't fully standardized cite the need for flexibility. Some departments need specialized tools that a shared platform cannot provide. That's a legitimate operational reality. But flexibility without coordination and interconnected eligibility data comes at a cost. When teams act on different versions of provider eligibility data, errors follow.
“We aim to optimize user experience by allowing teams to use tools best suited to their workflows.”
—Survey respondent
Read more about
SECTION 1
Almost Everyone Touches It, But Almost No One Shares It
Provider eligibility data is an enterprise-wide responsibility, but the enterprise is siloed.
SECTION 2
Confidence But With Caveats
Most leaders trust their provider eligibility data. But the key is understanding why— and why it also falls short.
SECTION 3
The Workflow Problem Mirrors the Data Problem
Fragmented data leads to fragmented workflows.
SECTION 4
Consolidation Of Data Is Already Happening
The push to streamline isn't a future initiative. It's underway.
SECTION 5
The Destination Is Clear, and The Journey Has Begun
An interconnected eligibility data exchange is where this industry is headed.
SECTION 6
What Progress Actually Looks Like
The organizations moving forward have a few things in common.
