As a result, health plans have an opportunity to re-evaluate how they present this data.
Outside of using a provider directory, consumers will often ask their physicians for a recommendation or turn to friends and colleagues for a suggestion of a provider. Health plan provider directories can provide additional context beyond those recommendations, showing a vast array of providers, including relevant credentials and quality reviews, and cost information when integrated with a healthcare cost transparency platform. With this meaningful data, health plans can serve as a trusted resource as members select and verify their provider choices. It is a critical opportunity to meet consumers’ expectations and present essential provider information in a user-friendly way.
Consumers use a provider directory at the beginning of their episode of care. Unfortunately, there is often substandard data during the early stages of the health shopping process, such as is reported by Health Affairs:
• 10 percent of the providers listed in their directory either were no longer with the group listed or had never been with the group at all.
• In 30 percent of the cases, the specialty listed in the provider directory did not match the one stated by the receptionist at the practice.
• 19 percent of providers of non-marketplace plans and 18 percent of providers of marketplace plans could not be reached at the telephone number listed in the directory because the line was disconnected, messages left were not returned, the wrong number was given or the line was constantly busy.
These percentages are not a majority, but are still a significant indicator of challenges with directories. Accurate data is expected by patients, and health plans should consider partnering with companies that have the expertise and integration capabilities to support frequent updates.
Years ago, it was easier to maintain a printed provider directory because updates were not as frequent. Now monthly, weekly or daily updates can tap into a greater pool of available information for networks or other configurations, causing data management to become a more difficult task.
Today’s environment demands a robust validation system that processes new provider data and matches it with unique IDs that avoid confusion over similar names or addresses. It’s a process that can clean, standardize and normalize data while distinguishing between networks, preferred providers and other plan-design specifications. While the provider will always have the responsibility to ensure their content is current, these solutions help to drastically improve that information.
The best option is a scalable system that is technically robust and streamlined to handle the vast amounts of data updates that today’s health plan experience demands. Health plans should collaborate with partners to standardized data and make it accessible via user-friendly solutions. This enables the health plans to focus on what they do best—serving their members as an insurance company.
For example, in when leveraging self-service validation portals, health plan administrators can view key statistics for each data update, gather provider information from a number of sources, and find areas for improvement. In this system, health plans can view the number of changes and where they were applied, compare the old data to the new, and monitor project statuses. It’s an opportunity to gain insights from the data.
With a scalable system helping with their provider data, the focus can be on the user experience. Health plans can restore patients’ trust by creating a connected, integrated solution to help consumers navigate healthcare and shop smarter.
Bio:
As SVP, General Manager of Change Healthcare Engagement Solutions, Tate McDaniel has collaborated with dozens of companies on strategic cost transparency and engagement healthcare solutions and has nearly 20 years’ experience in managing strategic partnerships and leading consultative sales strategies targeting Fortune 500 companies. He joined Change Healthcare in 2009 from SunTrust Bank, where he was director of Business Development for the bank’s corporate institutional division focusing on large corporate investment banking clients. He holds a bachelor’s degree in business administration from the University of Georgia and a master’s degree in business administration from Vanderbilt University.
Health Affairs Case Study:
http://content.healthaffairs.org/content/35/7/1160.abstract?sid=5fb917a3-6bf9-4127-8250-9c5798b67fd6
Becker’s Review of Health Affairs Case Study
https://www.beckershospitalreview.com/payer-issues/california-network-information-often-inaccurate-study-finds.html
Wall Street Journal: Directory Regulations:
http://www.wsj.com/articles/health-insurers-to-face-fines-for-not-correcting-doctor-directories-1451335323
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
