Unlocking Seamless Care Coordination: Improving Provider Data with Insights from Eric Demers, CEO of Madaket Health

Healthcare Access in Crisis: Millions Face Delays Due to Flawed Doctor Directories

Breaking News: A stark reality is emerging in American healthcare, where even insured individuals are significantly hindered in accessing care. New insights reveal that nearly half of the U.S. population delays or avoids necessary medical appointments simply becuase they cannot confidently identify in-network healthcare providers.

Published: August 16, 2025

The Invisible Barrier to Care

The ability to find a doctor who is actually covered by one’s insurance plan remains a critical, yet often overlooked, hurdle in the U.S. healthcare system. This issue is not confined to the uninsured; a substantial segment of the population,even those with complete coverage,are experiencing significant delays in seeking medical attention. This situation is driving many, notably younger demographics, to explore alternative or delayed care routes.

The core of the problem lies in the widespread prevalence of outdated, inaccurate, and poorly synchronized provider data. This data, which forms the backbone of insurance network directories and healthcare provider listings, is frequently riddled with errors. These inaccuracies create an invisible barrier,leaving patients frustrated and possibly compromising their health outcomes.

Root Causes of Provider Data Decay

Experts point to a systemic failure in maintaining accurate provider information. The lack of standardized national data protocols and the inconsistent systems employed by various insurance payers and healthcare providers exacerbate the issue. Even large, vertically integrated health systems find themselves battling internal data discrepancies.

This pervasive data decay means that when a patient searches for an in-network physician, the information provided may be incorrect, leading to appointments with out-of-network providers and unexpected costs. this not only impacts the patient financially but also erodes trust in the healthcare system.

Did You Know? A recent national survey indicated that approximately 47% of Americans have delayed care due to difficulties in finding in-network medical professionals. This figure is notably higher among millennials.

Madaket Health Addresses the Data Discrepancy

Companies like Madaket Health are stepping into this void, aiming to rectify the critical issue of inaccurate provider data. Madaket Health operates as a vital data intermediary, connecting payers and providers to ensure information accuracy and synchronization.

Their platform, reportedly utilized by over 80% of U.S. healthcare providers, serves as a robust solution to keep provider directories and network information current and aligned. By bridging the gap between disparate data systems, Madaket Health seeks to improve patient access to care and reduce the administrative burden on providers.

Impact of Inaccurate Provider Data

Metric	finding
Percentage delaying care	Nearly 50% of Americans
Primary cause for delay	Inability to find in-network providers
Demographic most affected	millennials (more likely to seek alternatives)
Underlying issue	Outdated, inaccurate, unsynchronized provider data

the Broader Implications for Healthcare

The ramifications of this widespread data inaccuracy extend far beyond individual patient frustration. It contributes to increased healthcare costs thru out-of-network claims, administrative inefficiencies, and potentially poorer health outcomes due to deferred treatment. Improving provider data accuracy is not just a technical fix; it’s a fundamental step towards a more accessible and equitable healthcare system.

Ensuring that patients can reliably access the care they need, when they need it, requires ongoing vigilance in data management and a commitment to nationwide data standardization. Technologies that facilitate real-time data updates and cross-system synchronization are becoming increasingly crucial.

Pro Tip: Before scheduling a medical appointment, always verify with both your insurance provider and the healthcare facility that the physician is indeed in-network for your specific plan.

What has been your experience trying to find an in-network doctor? Share your thoughts in the comments below!

How can healthcare systems better ensure provider data accuracy to improve patient access?

Evergreen Insights: Navigating healthcare Provider Networks

The challenge of finding accurate healthcare provider information is an ongoing issue that requires proactive strategies from both patients and healthcare ecosystems. Understanding the dynamics of insurance networks and the importance of up-to-date provider data can empower individuals to make more informed healthcare decisions.

For patients, maintaining a clear understanding of their insurance plan’s details, including network restrictions and coverage for out-of-network care, is paramount. Resources such as the centers for Medicare & Medicaid Services (CMS) offer valuable information on healthcare regulations and patient rights.

Healthcare providers and payers share a responsibility to maintain accurate and accessible provider directories. Industry-wide initiatives focused on data standardization and technological integration are essential for creating a more transparent and efficient healthcare marketplace. This continuous effort supports the fundamental goal of ensuring timely and appropriate medical care for all.

Frequently Asked Questions on Healthcare Provider Data

Why is accurate provider data crucial for healthcare access?

Accurate provider data is crucial as it ensures patients can find and book appointments with doctors who are covered by their insurance, preventing unexpected costs and delays in care.

What are the main reasons for inaccurate provider data in the U.S.?

The main reasons include a lack of national standards, inconsistent systems across payers and providers, and outdated or poorly synchronized information between different healthcare entities.

How does inaccurate provider data affect patients?

Inaccurate provider data leads to patients delaying care, seeking out-of-network providers unknowingly, facing unexpected medical bills, and experiencing frustration.

Which age groups are particularly affected by provider data issues?

Millennials are noted as being particularly affected,frequently enough seeking alternative care routes when faced with difficulties in finding in-network providers.

What is Madaket Health’s role in addressing this problem?

Madaket Health acts as a data bridge, using its platform to synchronize and update provider information between payers and providers, aiming to improve directory accuracy and patient access.

What can patients do to ensure their doctor is in-network?

Patients shoudl proactively verify with both their insurance company and the medical practice that the specific provider is covered under their plan before scheduling appointments.

Did you find this information helpful? share this article with your network and join the conversation in the comments below!

How can healthcare organizations prioritize the areas with the most meaningful impact on cost inefficiencies, patient care, or operational efficiency when improving provider data?

The Critical Role of Provider Data in Healthcare

The backbone of effective care coordination lies in the accuracy, completeness, and accessibility of healthcare provider data. This data encompasses a wide array of details, including:

demographics: Name, address, contact information, and other identifying details.

Specialty and Scope of Practise: The specific areas of medicine a provider specializes in.

affiliations: Hospitals, clinics, and other healthcare organizations the provider is associated with.

Credentialing and Licensing: Validations of a provider’s qualifications to practice medicine.

Insurance Information: Accepted insurance plans.

Incorrect or outdated provider data leads to significant challenges in healthcare, including:

Care Delays: Patients may experience difficulty finding or scheduling appointments with the right specialists.

Inefficient Operations: Healthcare organizations waste valuable time and resources validating provider information.

Financial Losses: Incorrect billing and claims denials can result in lost revenue.

Poor Patient Experience: Patients become frustrated by inaccurate information and a lack of seamless care.

Madaket Health: Transforming Provider Data Management

Madaket Health, under the leadership of CEO Eric Demers, is revolutionizing provider data management. Their platform centralizes, cleanses, and validates provider data, making it readily available to healthcare organizations.This has a ripple effect on numerous areas of care coordination and operational efficiency.

Madaket enables healthcare providers to:

Improve data Accuracy: Eliminate outdated or incorrect provider information through automated processes.

streamline Operations: Simplify administrative tasks associated with managing provider data,such as credentialing and network management.

Enhance Care Coordination: Facilitate seamless dialog and collaboration by providing access to up-to-date provider information.

Reduce Costs: Optimize resource allocation and minimize revenue loss from errors and inaccuracies.

Key Strategies for Improving Provider Data

Building on the insights from Madaket Health and general best practices, here are actionable strategies:

1. Establish Data Governance

Create clear policies and standard operating procedures (SOPs) for data collection, validation, and maintenance.

Define roles and responsibilities: Assign ownership for data quality and accuracy.

Implement data quality metrics: Track data completeness, accuracy, and timeliness.

2. Leverage Data automation

automate data entry: Utilize technology to reduce manual effort and minimize errors.

Automate data validation: Integrate systems that automatically check data for accuracy.

Implement automated data updates: Employ technologies to automatically update provider information from reliable sources.

3. Promote Data Integration

integrate data across systems: Share crucial provider data across all relevant systems within an institution.

Ensure interoperability: Facilitate data exchange between different healthcare organizations.

Use standardized data formats: Employ standard data models such as HL7 or FHIR to improve interoperability.

4. Conduct Regular Data Audits

Perform periodic data audits: Conduct audits to identify and correct data errors.

Implement feedback loops: Encourage providers to report data inaccuracies.

Continuously monitor data quality: Regularly review and update provider data to maintain accuracy.

Benefits of Improved provider Data Management

Implementing the discussed strategies can unlock significant benefits for healthcare organizations:

Enhanced Patient Experience: Simplified appointment scheduling, improved communication, and better care coordination.

Increased Efficiency: Reduced administrative burden, streamlined workflows, and optimized use of resources.

Reduced Costs: Lower operational expenses, decreased billing errors, and minimized denial rates.

Improved Compliance: Adherence to regulatory requirements related to provider data management.

Better Clinical Outcomes: Improved care coordination, leading to better patient outcomes.

Real-world Examples

Many healthcare organizations have successfully implemented provider data management strategies. Here are some examples:

Credentialing Automation: Healthcare systems have automated the credentialing process, drastically reducing the time required to onboard new providers.

Network Management Enhancement: Payers are using accurate provider data to efficiently manage their networks, resulting in improved patient access to care.

Practical Tips for Immediate Implementation

1. Assess Your Current State: Identify the current state of provider data management and assess where improvements can be made.
2. Prioritize Key Areas: Focus on areas with the most significant impact on cost inefficiencies, patient care, or operational efficiency.
3. Choose the Right Tools: Evaluate and choose data management solutions that fit your organization’s needs