Leadership | 01.06.25
Time for a Credentialing Shake-Up
By Robert Coombs and Tiffany A. Long, CPCS, CPMSM, FMSP
Healthcare is advancing rapidly, yet the system for vetting professionals lags. Licensing and credentialing — vital for patient safety and care quality — often become bottlenecks, causing widespread frustration and inefficiency.
This isn’t just a minor administrative issue — it’s a growing crisis. The gap between fast-paced medical advancements and slow credentialing processes threatens the entire healthcare system’s efficiency and effectiveness.
For decades, medical services professionals (MSPs) have been crucial in maintaining patient safety while striving to optimize their workflows. However, outdated processes requiring extensive manual data entry have become the norm. This time-consuming, error-prone work diverts MSPs from making complex, critical decisions — tasks that truly require human judgment.
Technological Solutions: Paving the Way for Efficiency
Emerging technologies offer promising solutions to these longstanding challenges:
- Cloud-Based Platforms: These systems centralize credentialing data, breaking down information silos and enabling real-time collaboration. Multiple stakeholders can access and update information simultaneously, reducing delays and boosting efficiency. Additional controls can restrict access to sensitive information, ensuring confidentiality.
- Automated Data Collection: Automating primary source verification minimizes manual data entry and reliance on incomplete self-reported information. This not only saves time but also reduces the risk of fraud by continuously updating records from reliable sources, keeping credentialing data accurate and current.
- Artificial Intelligence: AI’s growth in healthcare points to future opportunities to streamline credentialing by automating repetitive tasks. AI could assist credentialing committees by offering data-driven insights, historical patterns, and structured summaries for more informed decision-making.
Striking a Balance: Enhancing Roles Through Technology
Implementing these technologies can transform the roles of MSPs:
- Focus on High-Value Tasks: Automation of routine tasks frees MSPs to concentrate on complex issues that require their expertise and judgment. This shift is crucial, as it not only enhances operational efficiency but also directly addresses professional burnout. By alleviating the burden of mundane tasks, MSPs can focus on more impactful work, reducing workplace stress and fostering a more sustainable work environment.
- Improved Accuracy: Reducing manual data entry naturally leads to fewer errors, enhancing the overall quality of the credentialing process. Ensuring accurate and timely credentialing helps healthcare organizations avoid losing qualified clinicians to competitors with faster onboarding processes.
- Enhanced Job Satisfaction: By eliminating tedious tasks, MSPs can engage in more meaningful, impactful parts of their work, increasing job satisfaction and retention. This is essential for maintaining a motivated workforce, especially in an industry where the pressure of managing cumbersome processes contributes to professional burnout.
The benefits of streamlined credentialing extend throughout the healthcare ecosystem:
- Expedited Onboarding: Healthcare organizations can integrate new staff more quickly, potentially increasing their capacity to provide care. This is particularly important in underserved communities where access to care is already limited. Speeding up the credentialing process can help retain talented clinicians who might otherwise be lost to competitors due to delays.
- Reduced liability: A more efficient system for filtering out bad actors ensures a safer clinical environment and reduced liability for large organizations that lack transparency into their provider network. This transparency is crucial in mitigating risks, as reliance on self-reported information often leads to redundant efforts and increased liability.
- Cost Efficiency: Streamlined processes can lead to significant organizational savings, both in time and resources. Reducing redundancies, such as unnecessary duplication and follow-up tasks, not only improves cost efficiency but also decreases the administrative burden on clinicians, thereby contributing to a more sustainable and efficient healthcare system.
Conclusion: Shaping the Future of Healthcare Administration
The modernization of credentialing processes is not merely about improving administrative efficiency — it's about empowering healthcare professionals to operate at the peak of their capabilities. By embracing technological solutions, we can alleviate the burden on MSPs, streamline operations, and ultimately foster a more responsive, efficient healthcare system capable of meeting the challenges of modern medicine.
The time for incremental changes has passed. A comprehensive, technology-driven overhaul of the credentialing process is essential to ensure that our administrative practices keep pace with the rapid advancements in medical care. This transformation is crucial not just for the well-being of healthcare professionals, but for the overall quality and accessibility of patient care.
Robert Coombs is the founder and CEO of Baton Health, which is working to eliminate manual data entry through their Universal Primary Source. With extensive experience in healthcare and fintech operations, Robert has a proven track record of scaling teams and improving processes in regulated industries. His background includes leadership roles at Andros, Medallion, and Vestwell.
Tiffany Long, CPCS, CPMSM, FMSP, is the head of credentialing operations at Baton Health, where she leverages nearly 25 years of experience as an MSP. Tiffany has consistently focused on reducing redundancy and waste in the credentialing process by embracing technology and automation. Her extensive background includes leadership roles at SteadyMD, BlocHealth, and the Richmond Academy of Medicine. She also currently serves as faculty to NAMSS and is a past director at large.
Robert Coombs and Tiffany A. Long, CPCS, CPMSM, FMSP