What is Provider Harbor?
Provider Harbor is a national, collaborative, health care provider data warehouse designed to support the operational needs of health care organizations well beyond the basic requirements of credentialing.
The warehouse is assembled from polling a constantly-expanding variety of individual provider directories and reference information. The collected data are then mapped into a single, unified data model, while always retaining the source, date, and identifying information on each incoming data point.
The resulting warehouse is then accessible by:
- Web-based application supporting review, editing, analytics and inter-organizational reconciliation
- Standard export formats (e.g. Spreadsheet, XML, JSON, CSV)
- Pass-through query facility (SQL)
- Automated exports in commercial payer native formats
- Auto-generated PDF provider directories
- Arbitrary user-specified exports as operational workflow requires
The primary purpose of Provider Harbor is to establish a stable platform for healthcare organizations to perform high-precision tactical and strategic analytics on their provider network, and support their operational management. As a byproduct of achieving that goal, it also provides:
- Standardization of variation in data fields (e.g. = "101 North Main #200" "101 N MAIN STE 200" )
- Mapping of properties to unambiguous, industry standard coding (e.g. NUCC Taxonomy, FREIDA residency)
- Ability to reconcile differences in shared provider cohorts between independent organizations (e.g. between physician organization and commercial payer)
- Expose data quality issues by identifying properties where the organization's records are contrary to peer organizations (e.g. organization records provider phone number as 555-1212 where all peer organizations record 555-6767 for that same provider)
What Provider Harbor is Not
- "Yet Another Provider Directory"
- Provider Harbor is a master repository of all provider directories, structured to integrate a wide variety of individual organizations' provider data into a Single Source of Truth across the entire health care space. Provider Harbor is a virtual shipping port for provider information to and from organizations across the healthcare landscape.
- A credentialing system
- Although credentialing data are often absorbed additional sources for Provider Harbor, and the visibility into peer perspectives and accrued provider history can be an invaluable reference resource in the credentialing process, Provider Harbor's primary focus is supporting operational decision-making for health care organizations
- CAQH ProView/DataSpring
- CAQH can be a useful reference for credentialing, and can, itself, also be used as an additional source
for Provider Harbor. However, Provider Harbor in distinct from CAQH in several important ways:
- CAQH is focused on supporting credentialing workflow, whereas Provider Harbor is focused on supporting provider network administration.
- CAQH primary data source is the provider themselves (or provider's designee), who is not actually an authoritative source for anything. Provider Harbor obtains information directly from authoritative sources, and manually-keyed data is typically a secondary supplement.
- Although both systems use information from USPS address validation, State Licensing and certification boards, Provider Harbor also automatically updates source data from Hospitals, Hospital systems, physician organizations, CMS, Provider State business records, and other sources of information critical to provider network management.
- The CAQH information domain is limited to the context of provider credentialing. Provider Harbor extends this domain to include organizational-specific identifiers, payer contracting, physician organization, ACO and department membership, EMR and payer relationships and identifiers, sub-specialties and clinical interests, geocoded locations, public-facing provider directory support (such as biographical statement and publications), and growing.
- CAQH maintains a single "perspective" of provider information (that of the provider themselves), Provider Harbor maintains multiple (often dozens) of organizations' individual perspectives, for the same provider, concurrently
- An intended design, list of proposed capabilities, or a future plan
- Provider Harbor is a fully operational system, in production, in use by health care organizations, right now.
Healthcare Organizations: "So some of the provider data is wrong, who cares?"
For commercial healthcare payers, physician organizations, hospital and healthcare systems, the provider network is their product. To be successful, an organization needs confidence that they have a reliable source for, at an absolute minimum:
- Who their providers are
- Where they practice
- What they specialize in
- How to contact/refer to them
- Current credentialing and patient-accepting status
Despite the essential nature of this information, keeping the information complete and current is an industry-wide struggle. In 2018, CMS completed a systematic review of 5,602 healthcare providers across 52 Medicare Advantage organizations, and found that just within the context of phone number, location, and new-patient-acceptance, their provider information was wrong, on average, for nearly half of all providers. This is the exact operational challenge that Provider Harbor was designed to address.