7 Pain Points Driving Administrative Burden Across Healthcare

Across healthcare, administrative burden is one of the biggest barriers to progress. Providers want to spend more time caring for patients and less time navigating paperwork. Hospital systems are under pressure to streamline workflows, control costs, and improve access and experience. Health plans, which finance much of patient care and connect providers, systems, members, and regulators, face growing operational demands of their own.

At CertifyOS’s Blueprint Conference, healthcare leaders shared firsthand how administrative burden affects every corner of the system, from member experience and provider credentialing to network accuracy and care access. Despite their different roles, one message was clear: every stakeholder wants to reduce administrative overload. What they’re looking for aren’t short-term fixes, but scalable, long-term systems that simplify operations and support the healthcare ecosystem for years to come.

Throughout the event, several pain points surfaced again and again. In this article, we highlight the most common drivers of administrative burden, and how CertifyOS is helping payers, providers, and health systems move past them and refocus on what matters most: patient care.

Pain Point 1: Rising Administrative and Operational Costs

Who It Hurts the Most: Payers and Hospital Systems

Hospital operating margins are rapidly shrinking. Demographic shifts, including a growing population over 65 years old, rising cancer incidence, and increasing obesity rates, have driven up the cost of care. At the same time, labor shortages, inflation, technology demands, and reimbursement constraints continue to push operating expenses higher. One of the most persistent and difficult cost drivers to control is administrative overhead.

Provider data management is a clear example. Hospital systems invest heavily in maintaining provider directories and managing credentialing, privileging, and internal data reconciliation. Payers spend equal (if not greater) resources ensuring their networks are accurate and compliant. With thousands of providers across departments and locations, the time spent updating data, responding to requests, and meeting regulatory requirements adds up quickly.

Much of this work is supported by manual, duplicative, and reactive systems, requiring large administrative teams simply to keep operations running. As a result, the National Library of Medicine estimates that nearly one-quarter of healthcare hours are spent on administration.

Pain Point 2: Reliance on Legacy Systems

Who It Hurts the Most: Payers and Hospital Systems

Outdated technology is a major contributor to rising administrative costs. As Christopher Kerns, CEO of Union Healthcare Insights, notes, many administrative teams are expected to streamline workflows using systems built decades ago, tools that create inefficiencies rather than eliminate them.

Technology has always been expensive, and because of this, healthcare has historically been slow to adopt new systems. For example, in 1970, a supercomputer capable of processing the amount of data our modern laptops can handle cost more than $460,000, which is equivalent to more than $5 million today. That’s a lot of money to spend on something that has an uncertain ROI.

A system-wide hesitation to make large technology expenditures has led to a continued reliance on legacy platforms and manual processes. While the upfront cost of modernization can feel like a barrier, the reality is that the healthcare ecosystem could save billions by investing in modern infrastructure. In many cases, hospital systems see meaningful returns on these investments far sooner than expected.

Pain Point 3: Mixed Incentives

Who It Hurts the Most: Payers

The financial case for administrative automation is clearest for payers. According to the CAQH Index, health plans could save $187 billion annually by automating administrative transactions alone. Yet much of the administrative burden still falls on providers and hospital systems, who often lack the same financial incentives to modernize.

Provider data management illustrates this imbalance. While accurate data benefits everyone, providers are responsible for keeping their information up to date, often across multiple systems, in multiple formats, through manual processes. They shoulder much of the work while realizing only a fraction of the financial upside, creating inefficiencies that ripple across payer operations.

Pain Point 4: Growing Clinical Burden

Who It Hurts the Most: Providers and Hospital Systems

One of the most concerning trends in healthcare is the growing administrative workload placed directly onto clinicians. Doctors, nurses, and other care team members increasingly manage tasks like scheduling, insurance submissions, data corrections, and technology troubleshooting, all on top of delivering patient care.

Even with digitized records, many Electronic Health Record (EHR) and provider data management systems remain complex, click-heavy, and duplicative. Clinicians spend hours on administrative work each week, time that could otherwise be spent diagnosing, treating, educating, or connecting with patients. The result is burnout, reduced productivity, workforce strain, and less time for care.

Pain Point 5: Network Management Complexity

Who It Hurts the Most: Everyone!

Provider networks sit at the center of health plan operations, and as with many things in the health care world, they are more complex than ever. Payers must track credentialing, contracts, directory accuracy, coverage areas, specialties, and capacity across thousands of providers. Networks are constantly changing, and even small inaccuracies can have outsized consequences.

When network data is wrong, patients can’t find care, providers don’t get paid, payers struggle to meet access requirements, and hospital systems can’t effectively serve their communities. And (as you can probably guess) all of the member abrasion, frustration, and administrative work to deal with it falls on the payers.

Pain Point 6: Data Integration Challenges

Who It Hurts the Most: Providers and hospital systems

While payers sit at the center of the healthcare ecosystem, their data often does not. Disparate, siloed systems that don’t communicate force providers and systems to submit information repeatedly, in different formats, and with inconsistent standards.

This fragmentation makes even simple tasks (such as verifying a location or a credential) time-consuming and error-prone. Administrative efficiency depends on clean, connected, interoperable data and a single source of truth supported by modern, continuously updated infrastructure.

Pain Point 7: A “Dirty Pool” of Provider Data

Who It Hurts the Most: Payers

As Mike Kane, SVP of Provider Data Operations at UnitedHealthcare, recently shared, even strong data management processes can fall short if they’re built on flawed data. His team followed best practices (cleaning incoming files and ensuring accuracy), yet still struggled with an underlying “dirty pool” of provider data.

Because provider information constantly changes, data degrades over time. Without addressing the foundation, cleanup efforts become endless. Some databases carry error rates as high as 5%, exposing payers to compliance risk and regulatory fines. As Jamila Sykes, VP at Highmark Health, notes, even a small percentage of inaccurate records can translate into hours of additional work and even regulatory risk.

CertifyOS is Supporting All Stakeholders

At CertifyOS, we’re committed to removing the administrative obstacles that slow healthcare down. By modernizing provider data management, streamlining credentialing and roster management, and supporting compliance, we help clinicians spend less time on paperwork and more time delivering care.

Provider data management sits at the intersection of patient access, provider experience, and network performance. Our modern, API-driven platform helps payers reduce administrative costs, improve accuracy, and maintain compliance, saving millions of dollars and thousands of hours while strengthening the entire healthcare ecosystem. When administrative burden goes down, providers thrive, systems grow, and patients win.