One of the biggest challenges in the healthcare is the plan provider directory. Inaccuracies in provider directories are a nightmare for companies like Evolent Health. They are expensive to manually fix, can cause compliance issues, and lead to claims processing errors.
As value-based healthcare organization that worked directly with provider-led organizations, Evolent Health saw provider data management as a key strategic competency. What Evolent did not know, was how exactly its solution could uniquely help its partners. It needed to answer questions like: What are the key issues facing partner networks? Is it as simple as gathering accurate data? What, if any, additional insights are needed?
Our team spent time learning from our internal stakeholder partners about their particular challenges, but knew that we also needed to hear from our potential end users to learn about additional use cases and workflow issues.
We started by learning as much about provider data management as we could. We then took our findings, along with Evolent’s evolving business goals, and described a vision for a provider data management solution that has continued to help guide development today.
We interviewed network performance managers, population health managers, and finance associates to get a better sense of what provider data management meant to them. We then held a follow-up workshop with those same users, where used the insight gained in our individual sessions, to build out what we came to call the "Provider Relationship Life Cycle".
As we reviewed our findings, we realized that maintaining accurate provider data was only one of the challenges our users were facing. It was also about things like managing provider spend, credential validation, network adequacy, and referral efficiency.
These various components of the provider/plan relationship had always been managed through emails, written worksheets, databases, and spreadsheets. It led to confusion, inefficiency, and lost work. What our partners needed was a tool that could help them track and manage all of this valuable information in one place.
We knew that the business stakeholders would not be keen on committing to decade-long commitment to build a Salesforce competitor, so we while we presented our end state vision, we were also clear that the product would need to be built in phases. Phase one was to be all about provider data management — our initial goal — the one that was the most pressing need for the business.
Using this phased approach, we were able to make the case for both near and long-term viability to our stakeholders, and our product partners were able to find resources to commit to the first phase of development.
When we learned six months into development that the timeline for provider credentialing needed to move forward, we were ready. When provider performance management was deemed more important to the business than network adequacy, we needed little adjustment to alter our course. While various other product initiatives have stalled when business needs have changed on the fly, Identifi Network's development continues to be a key area of focus for the product development team.