If knowledge is power, most Americans lack power when it comes to choosing healthcare providers because the quality of resources and number available is poor.
America’s Health Insurance Plans (AHIP), a national political advocacy and trade association, has commissioned a pilot program to improve the way information is gathered for provider directories. These directories are used by consumers to choose health plans and providers. AHIP representatives said the quality of information provided to directories can be made more accurate and timely by providing better coordination between providers and health plans.
Ari Tulla, co-founder and CEO of BetterDoctor, a company that provides data and platforms for managing provider directories, pointed out that about 20 percent of doctors move or change practices, making information unreliable. Current procedures rely on health plans making calls, sending faxes and emails, and in-person visits to providers to get information. Paul Markovich, who is leading AHIP’s task force on the AHIP pilot project, said it takes both providers and health plans to make the directories work and there needs to be a “single stop” for updating this information.
The pilot program started in April 2016 in Indiana, California and Florida. The pilot program incorporates recent regulatory changes related to network directories, including:
- Medicare Advantage regulations requiring quarterly outreach to providers to verify key directory data in 2016
- California legislation — SB 137 — requiring bi-annual validation of providers’ data for individual and institutional providers
- California Department of Insurance network adequacy regulations
- Federal standards for qualified health plans participating in the federal marketplace.
Twelve health plans representing more than 100,000 providers are participating in the pilot. The plans represent commercial, Medicaid and Medicare Advantage markets and include:
- Blue Shield of California
- Florida Blue
- Health Net
- L.A. Care Health Plan
- Molina Healthcare of California
- SCAN Health Plan
- Western Health Advantage.