The Future of Provider Data: Moving from a Directory Problem to a Growth Engine

At Blueprint 2026, three of healthcare's sharpest minds sat down to wrestle with a question the industry has been circling for decades: what will it actually take to fix provider data? Here are the five moments that cut through the noise.

1. The Process Hasn't Changed, But Our Ability To Execute Has

One of the session's first, and most disarming, admissions came from Sarah Ahmad, CEO at CAQH, and who spent 22 years at Humana: the core steps of provider credentialing today look remarkably similar to what they looked like in the early 2000s. The regulations are largely the same. The workflow is largely the same.

But something has shifted. The technology applied to those steps—AI-assisted data cleansing, universal credentialing applications, cross-industry collaboration—has meaningfully accelerated them. Simon Hayhurst, CPO at CertifyOS, framed it succinctly: the hard thing is still getting data you can trust, but the ability to deal with data at scale is becoming far easier.

The takeaway isn't discouraging—it's clarifying. The foundation is still being poured. That's exactly the right place to focus investment and innovation.

"The more things change, the more things stay the same—but the technology has sped up the steps considerably."

— Sarah Ahmad, CEO, CAQH

2. Providers Are Out-Adopting Health Plans On AI—And There's a Lesson in That

The American Medical Association (AMA) recently published data showing more than 80% of physicians are now using AI professionally. Tools like ambient scribe technology and OpenEvidence (used by 50%+ of clinicians) have taken hold not through mandate, but through sheer value delivery.

Hayhurst shared a striking example from his time at Virta Health: an AI tool that helped coaches draft patient replies saw adoption jump from 17% to 78% in just 18 months—with no requirement to use it. Coaches simply found it worked better than what they could produce themselves.

The contrast with the health plan side is telling. As Millie Virgil, former SVP, Transformation and Customer Experience at Blue Shield of California, explained, legacy systems at health plans are so deeply entrenched and customized that wholesale replacement is nearly impossible. The path forward requires identifying the highest-friction points first—and proving ROI before asking for organizational change.

"You'll see fast adoption where delivered value is high. There's so much that is rote and routine—that should not be a manual thing."

— Simon Hayhurst, CPO, CertifyOS

3. Provider Data Management Shouldn't Be a Competitive Sport

No one in the room raised their hand when asked if their organization competes on the basis of its provider data. That says everything.

The panelists were direct: the foundational layer of provider data—credentialing, directory maintenance, data cleansing—is not where differentiation happens. It's infrastructure. Sarah Ahmad noted that some health plans are spending $100M–$200M on provider data management across the enterprise and asked the room a pointed question: is this really where you want to be spending?

Millie Virgil made the case for what collaboration could unlock: a shared credentialing infrastructure frees health plans to compete on what actually matters to members—plan benefits, the member experience, and increasingly, the quality and richness of data surfaced to help people make informed care decisions.

"The differentiation becomes the member experience, the enrollment process, the plan benefit structures you create. We don't need to be competing on foundational provider data—that should be collaborative."

— Millie Virgil, Former SVP of Operations, Blue Shield of California

4. The Directory of the Future Is a Care-Matching Engine, Not a Lookup Table

The current provider directory, in the eyes of this panel, is a relic. Providers themselves largely don't care about it—it's not how patients find them. And most members with healthcare access and social capital don't use directories either; they ask someone they trust.

But for the members who need it most, the stakes are high. Sarah Ahmad noted that CAQH holds data across nearly 3,000 fields per provider—including languages spoken, fellowship training, office hours, and more—much of which never makes it into a public-facing directory.

Simon Hayhurst pointed to advertising technology as a model: micro-pattern personalization powered by millions of variables, applied to healthcare. This could mean matching patients to providers not just by geography and network status, but by cultural competency, chronic disease specialization, communication style, and real-world access metrics like actual wait times.

"I'm amazed we can understand our Uber driver's rating—but we can't understand the quality score of the pediatrician we're signing our kids up for."

— Millie Virgil, Former SVP of Operations, Blue Shield of California

5. The Walls Between Data Systems Are About To Come Down—If We Let Them

Simon Hayhurst drew a comparison that landed: 2026 is being discussed in technology circles the way 1989 is discussed in geopolitics. A wall has come down. The ability to build and deploy technology has been democratically transformed.

The practical implication for provider data: the friction of connecting disparate systems—the field-mapping exercises, the manual reconciliation, the endless vendor integrations—can now be automated in ways that were research projects just a few years ago.

But there's a critical caveat: those walls only come down if we choose not to put them back up. If the industry continues to silo data, restrict interoperability, or compete on foundational infrastructure, the technology will have nowhere useful to go. The urgency is now.

"The pace at which technology can currently change outstrips the capacity for people to change. That's the first really hard truth—and also where the biggest opportunity lives."

— Simon Hayhurst, CPO, CertifyOS