Payors’ directories win by adopting a purpose-built provider platform…and having it fed by health systems’ provider data
By Keith Belton & Rebecca Jones | December 23, 2019
Provider directories –offered by payors or state-level organizations – have noble causes to play as vital resources to help consumers find the right caregiver. The quality of their information directly correlates with consumer experience. Yet, today’s approaches are plagued with deficiencies.
It’s not for lack of understanding the problem. The Centers of Medicare and Medicaid Services completed a study examining the quality of Medicare Advantage (MA) online provider directories, taking a close look at Medicare Advantage Organizations (MAO) provider directory data, including a focus on location accuracy.
The results were alarming. The study examined the accuracy of 108 providers and their listed locations, selected from the online directories of 52 MAOs – approximately one-third of all MAOs – which brought the total to 5,602 providers reviewed at 10,504 locations. The findings revealed that roughly 49% of all providers had at least one inaccuracy. Types of inaccuracies included:
The provider was not at the location listed
The phone number was incorrect
The provider was not accepting new patients when the directory indicated they were
CMS calculated that the average directory’s location inaccuracy rate was 45 percent.
Consumers and caregivers rely on provider directories to make informed care decisions. Provider directories that contain inaccurate data constitute a barrier to efficient care.
Why is it such a challenge to maintain up-to-date provider directories, especially when there are federal and state level regulations which penalize errors?
Complexity is one challenge. Providers usually contract with multiple health plans and networks – the average provider participates in 20+ plans.
Lack of consistent provider outreach is a second. Provider directories themselves have no built-in digital outreach methods to regularly poll providers or staff to updates their health plan status.
The Jury is Out on States’ Noble Efforts to Solving the Provider Directory Challenges
California is one of several states attempting to address this challenge by creating a state-wide provider directory. Symphony Provider Directory (formerly the California Provider Directory Utility) offers a single place for healthcare providers and commercial health plans to update their data. The goal is to provide a simplified process to maintain more accurate provider data and present a better customer experience.
Symphony Provider Directory aims to pave the way in creating a new and effective way plans and providers exchange and receive provider information, having soft launched in 2018 and aiming for state-wide implementation by 2023.
Other states have struggled and have hit roadblocks. The Oregon Health Authority (OHA) had plans to implement concurrent provider data efforts to support provider directories. The Oregon Provider Directory (ODP) was created to support coordinated care, increase efficiencies, improve security and privacy, and enhance reporting capabilities. The Oregon Common Credentialing Program (OCCP) was to reduce burdens on practitioners, eliminate duplication, and reduce third-party verifications by providing timely and accurate provider data information during the credentialing process.
However, further work on the OCCP was suspended in 2018 as the “project ended up being more complex, more expensive, and has taken considerably longer to implement than anyone predicted. OHA encountered significant challenges in designing a program that addressed the complexities of business practices while meeting accrediting entity standards for credentialing.”
Provider Participation is Vital to Payor Directory Success
State-level payor directory projects would be more likely to succeed via direct collaboration of provider organizations. There are 2 reasons for engaging providers:
1. One of the worst kept secrets is that provider organizations, not payors, have more accurate health plan and network participation data about their providers.
2. Provider organizations have had far more success deploying a provider information management platform which has continuously-curated provider health plan and network participation status.
A good provider information platform has the piece which state provider directories desperately need – curation workflows that assist in digital provider outreach, so providers or delegates can easily update profiles, worklists, and real-time feeds and updates from health systems.
Net, net…success of the Symphony Provider Directory (or any statewide directory) will rely heavily on provider organizations to continuously update it with good data.
Phynd – Provider Information Management Platform
Good news: there are now platforms for provider organizations to easily curate and maintain provider data, in a more automated fashion. A number of health systems in California have deployed one such platform – at least one health system is planning on serving as a pilot in the Symphony process to feed its own internally-curated provider and location data to Symphony to support the cause.
The Phynd 360 Platform is one of those. Phynd’s National Provider Network is comprised of 4.7 million providers, with each provider profile containing 500 field data points, and fed by CMS, NPPES, ABMS, OIG, DEA, and state-level medical boards, among others. Some of these fields include:
What networks they serve
The health plans they accept
Their specialty, subspecialty, and clinical and patient-friendly search terms
The locations where they work
If they are accepting new patients
The Phynd data platform allows a two-way feed – between the health system and Phynd’s provider network – which means data is continuously curated, updated and far more accurate. Phynd will also feed the Symphony Provider Directory with data from its many CA health system participants, ensuring better provider data in Symphony.
Organizations who adopt this platform ensure their patients and referring staff find doctors who are in their network, delivering care that is critical to their health. They can also connect to the statewide provider directory as a vital feed of curated data about their thousands of providers.
More to come as Phynd monitors these developments…
 This is the average inaccuracy rate by location across all 52 MAOs. This differs from the overall inaccuracy rate of 48.74% because some MAOs had multiple locations listed for individual providers, resulting in many more locations for these MAOs.
 The State of Oregon similarly has kicked off an initiative – the Oregon Provider Directory – to tackle the challenge. https://www.oregon.gov/oha/hpa/ohit/pages/pd-overview.aspx.