Latest / The Mental Health Evolution / Ep 43: When Payers Own the Data: What the CAQH Rebrand Means for Providers

Transcript

Ep 43: When Payers Own the Data: What the CAQH Rebrand Means for Providers · The Mental Health Evolution

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  (Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick podcast
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  network.
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  Learn more at listenfrederick.com.
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  Welcome to Mental Health Evolution, a podcast about
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  what's changing in mental health and why it
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  matters.
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  I'm your host, Rachel Harrison, inviting you into
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  honest conversations with people from all perspectives in
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  the field, clinicians, tech founders, investors, insurance companies,
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  and all the folks in between.
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  Let's explore what's working, what's not, and what's
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  next.
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  Welcome back, everyone, to the Mental Health Evolution
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  podcast, where we explore changes happening in the
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  mental health industry and discuss why they matter.
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  Although we usually have guests on the show,
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  we do solo episodes.
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  And today I wanted to jump on here
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  based on something that is happening currently, a
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  lot of conversation around the CAQH changes.
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  So CAQH is the credentialing organization that most
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  of us in mental health practice have been
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  using for years.
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  It has officially this week rebranded as DataSpring.
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  And while a name change might sound like
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  a minor administrative update, the full picture of
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  what has happened here is worth understanding.
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  So today I want to talk through what
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  we know, what questions people are raising, and
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  where I think we need to keep watching
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  as this story develops.
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  I also want to share some resources with
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  you so you can dig in further on
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  your own.
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  This is a developing situation, and I do
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  not think any of us have the full
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  picture yet, but I thought it was important
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  to begin the conversation while it's top of
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  mind.
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  Before I get into discussing this more, I
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  want to highlight some reading for listeners that
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  want to go deeper, and these will be
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  linked in the show notes.
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  I also want to let you know that
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  one of the resources I'm including today is
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  from a private company blog rather than independent
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  news outlet.
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  That's not typically how we source material for
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  this show, but I'm including it because the
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  concerns it raises reflect what I have already
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  been hearing from clinicians I am speaking with
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  and seeing in conversations.
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  I will note that context when we get
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  to it.
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  The first article is titled CAQH Rebrands as
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  Data Spring to Power the Next Era of
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  Healthcare Data.
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  This is from Globe News Wire, and this
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  is the official announcement from the organization itself
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  published on June 8, 2026.
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  It lays out the rebrand, the new name,
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  and how the organization is framing this change
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  for the industry.
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  The next article called Leading Health Plans Become
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  CAQH Owners to Shape the Future of Healthcare
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  Data is from Becker's Payer Issues, January 2026,
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  and this piece covers the ownership restructuring that
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  happened earlier this year when CAQH converted from
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  a non-profit and became owned by a
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  group of major health insurance companies.
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  This is important background for understanding the full
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  picture of the evolution.
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  And article number three is called Insurer-Owned
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  CAQH Rebrands to Data Spring.
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  This is Becker's Payer's issue from June 2026,
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  and it's the follow-up coverage of the
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  rebrand itself, including comments from the CEO about
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  what it is and what it is not
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  changing operationally, and additional context on the insurer
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  ownership structure.
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  The last article is the one that is
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  from a blog of a private revenue cycle
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  management called Ventra Health, and it's titled, When
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  Payers Own the Data, What CAQH's New Structure
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  Means for Provider Revenue and Credentialing.
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  They are not affiliated with CAQH or Data
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  Spring.
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  I want to be clear that this is
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  not the kind of independent journalism we typically
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  point to, and you should read it with
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  that in mind.
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  But the concerns it outlines around credentialing delays,
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  enrollment decisions, and payer control of provider data
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  are the same concerns that have been coming
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  up in my conversations with other clinicians and
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  practice owners.
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  So I felt it was worth including while
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  we wait for more independent reporting to catch
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  up.
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  So let's dig in a little bit more
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  to this issue and what is going on
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  for anyone not deeply familiar with CAQH, because
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  I think that context definitely matters here.
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  CAQH, which stands for the Council for Affordable
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  Quality Health Care, has been around for over
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  25 years.
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  Most clinicians and practice owners know it as
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  the portal where you maintain your credentialing information,
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  you enter your license, your training history, your
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  liability insurance, your practice address, and all of
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  that data gets shared with insurance plans that
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  you authorize to access that data.
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  And the idea is that you enter it
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  once and it flows out to multiple payers
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  rather than filling out the same information over
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  and over again for each insurance company separately.
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  I remember before CAQH was a thing, we
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  had very thick application packets that had to
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  be filled out by hand for each individual
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  insurance provider.
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  So the idea was this is a way
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  for those providers to verify that information without
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  having to have each provider fill out that
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  large packet of information.
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  And for a long time CAQH operated as
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  a non-profit.
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  It was originally created by a coalition of
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  health plans to streamline shared administrative processes and
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  it became an essential piece of infrastructure for
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  the industry.
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  Most of us in practice have had to
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  use it whether we loved it or not
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  because so many insurance panels require it as
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  part of their credentialing process.
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  Credentialing meaning the way that someone becomes in
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  network with an insurance provider.
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  So that is the foundation.
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  CAQH has been a non-profit utility that
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  providers enter data into and insurers pull from
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  to manage credentialing and provider directories.
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  In fact, providers every 90 days have to
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  do what's called a re-attestation, which they
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  go in and verify their information for this
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  directory.
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  Now, the change in January 2026, CAQH announced
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  that it was no longer operating as a
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  non-profit.
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  Instead, it became owned by a consortium of
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  12 shareholder companies affiliated with the nation's largest
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  health plans.
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  We're talking about United Health Group, Centene, Aetna,
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  Elevance Health, Cigna, Humana and several Blue Cross
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  Blue Shield plans.
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  The official framing was that this new structure
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  would allow the organization to invest more aggressively
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  in technology, deepen partnerships and accelerate product development.
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  The CEO at the time said the goal
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  was to reimagine the data infrastructure behind care
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  so the system works better for everyone.
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  And if you pause a moment, what this
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  means structurally is that the organization providers are
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  required to submit their data to is now
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  owned by the very insurers that data gets
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  shared with.
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  That is worth sitting with.
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  In June 2026, the rebrand to DataSpring happened.
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  So, this past week, the next chapter arrived.
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  On June 8th, CAQH announced that it is
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  rebranding as DataSpring, powered by CAQH.
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  The announcement was timed to coincide with the
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  AHIP 2026 conference, which is a major gathering
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  for health insurance executives.
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  The new CEO, Sarah Ahmed, said the rebrand
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  reflects the organization's central role in developing a
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  connected healthcare ecosystem.
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  She said DataSpring wants to be seen as
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  more modern, more innovative and more focused on
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  improving the provider experience.
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  The name change is intended to signal a
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  fresh direction.
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  As she described it to Beckers, the team
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  wanted something energized and they settled on DataSpring
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  because it could mean both a water spring
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  with data flowing freely and a physical spring
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  that adapts to the industry.
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  In terms of what is operationally different right
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  now, the answer from the organization is not
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  much, at least not yet.
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  Your portal login still works, your data is
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  still there, your workflow is unchanged.
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  The website has a new name and there
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  is a new domain, dataspring.com, in addition
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  to caqh.org.
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  But the CEO has said that in the
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  months ahead, DataSpring plans to launch new data
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  solutions built on the existing foundation.
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  So, the question a lot of people are
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  asking is, what does that actually mean and
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  who benefits?
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  The concerns being raised are these and this
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  is where I want to spend some time
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  because I think it's where the conversation is
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  really happening.
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  The core concern I keep hearing is that
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  is reflected in some of the reading I
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  am pointing you to today is about the
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  structure of who now controls this data and
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  what their incentives are.
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  Also wondering what the uses will be for
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  this data.
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  CAQH is not just a convenience tool, it
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  is the upstream system of a record that
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  affects whether a provider gets credentialed, whether they
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  show up accurately in insurance directories, and ultimately
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  whether their claims get processed correctly.
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  When that system was a non-profit, the
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  argument was that it existed to serve the
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  whole ecosystem.
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  Now that it's owned by the major payers,
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  the question becomes whether the interests of providers
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  and the interests of insurers who own the
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  platform are always going to be aligned.
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  And history in healthcare suggests that is not
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  something that we should assume.
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  Some of the specific questions being raised include,
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  will payers use this platform in ways that
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  benefit their own administrative processes at the expense
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  of provider experience?
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  If your data is slightly out of date
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  or incomplete, will that be used to slow
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  down credentialing, delay directory listings, or flag claims?
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  And more broadly, what oversight exists over how
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  that data is used when the governing board
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  is made up of representatives from the same
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  insurance companies pulling the data?
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  I want to be clear that none of
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  this is confirmed.
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  This is a new situation.
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  We do not yet have evidence that providers
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  are being hurt by this change, but these
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  are reasonable questions to be asking, and I
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  think we would be doing ourselves a disservice
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  if we just accepted the rebranded face value
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  without understanding the structure behind it.
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  I also think there is a practical takeaway
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  here regarding of how this plays out.
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  Make sure your CAQH profile is current and
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  complete.
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  That has always been important, but given the
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  increased scrutiny that may come with this shift,
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  it's worth making sure your attestation is up
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  to date and that every piece of information
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  in your profile is accurate.
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  So where do we go from here?
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  This story is still developing, the rebrand just
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  happened, and the independent reporting has not fully
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  caught up.
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  I expect we will see more analysis from
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  health policy journalists and industry watchdogs in the
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  weeks ahead, and I will be keeping an
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  eye on it.
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  What I am hoping to see more of
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  is clear information about data governance and what
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  safeguards exist to protect providers, more transparency about
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  what new products DataSpring is planning and how
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  they will affect providers versus payers, and some
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  independent analysis of what this ownership structure actually
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  means for the field over time.
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  If you are a practice owner or a
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  clinician who has thoughts or experiences related to
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  this, I would genuinely love to hear from
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  you.
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  This is exactly the kind of topic where
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  voices from the ground matter and where our
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  community's collective knowledge is going to be important
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  as we figure out what this means for
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  how we practice.
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  I will link all of the resources we
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  discussed today in the show notes and I
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  encourage you to read them, draw on your
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  own conclusions, and stay engaged as this continues
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  to unfold.
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  One of the things that we do know
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  is that insurance companies are owning more and
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  more pieces.
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  They're owning outpatient clinics, they're owning now our
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  data and our data processing, as well as
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  determining who makes the claims.
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  So this consolidation piece, this insurance ownership of
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  lots of pieces of the treatment ecosystem is
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  a pattern and this is one piece of
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  that pattern.
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  So as you think through this, as you
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  consider this for yourself, we will continue talking
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  about it here and I will be looking
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  for guests and thinking of things that we
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  can update you in real time.
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  So thank you for tuning in, listening to
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  today's episode.
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  This is one of those situations where I
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  think awareness matters even when we don't yet
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  have all of the answers.
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  CAQH has been a foundational piece of how
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  providers manage credentialing for a long time and
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  a structural shift of this size deserves our
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  attention.
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  We will continue following up and I will
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  keep sharing updates as the picture becomes clearer.
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  As always, thank you for being part of
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  this community and for the work that you
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  do every day.
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  We will be back in the next episode
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  with more conversations about what is changing in
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  mental health and what it means for all
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  of us.
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  Bye for now.
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  Thanks for listening to the Mental Health Evolution
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  podcast.
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  Join the conversation, find us on social, send
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  us your thoughts and tell us what you're
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  seeing in your corner of the mental health
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  world.
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  Until next time, stay curious and keep evolving.