Lessons Learned From AHIP’s Provider Directory Pilot Program

by Jeanette Thornton

November 2, 2016

Consumers need accurate, actionable information. When they do, they can make the best decisions for them and their families. A key starting point for consumers is knowing their providers – and health plans are working hard to make provider directories as effective and up-to-date as possible.  That’s why we’ve led a substantial pilot program to give consumers access to even more accurate information when searching for a provider. After reaching the six-month mark, we wanted to share what AHIP and the participating health plans have learned thus far.

To recap, the pilot program had three goals:

  • Improve the accuracy of provider directories to benefit consumers regardless of whether they are covered by private insurance or public programs such as Medicare and Medicaid;
  • Reduce the number of provider calls and contacts and develop a more efficient approach for providers to update their information for ALL plans; and
  • Test different approaches to identify the most effective path to a potential solution at a national level.

The project impacted three states, (California, Florida, and Indiana) – where 13 AHIP member plans interacted with more than 400,000 providers and received over 65,000 responses. We proactively approached providers and their staff with phone calls, faxes, emails, and alerts within existing online portals asking them to update important data – such as address, phone number, specialty, and type of insurance accepted. Health plans collected and processed information about new locations and contact information, recent provider retirements and staff changes, and languages spoken by office staff.

The project built on the industry’s ongoing efforts to improve consumers’ access to care and to provide the information they need to make informed health care choices. NORC at the University of Chicago is conducting an independent evaluation of our initiative with final results expected in December 2016. Preliminary findings demonstrate:

  • Strong partnership and active participation with physician practices is essential. However, physician practices often remain unaware of how important it is to update the information that consumers access online;
  • Managing this data is complex for health plans, and standard formats would make it easy to process what data has been updated;
  • Data from individual providers sometimes don’t match the data provided by the group administrator; and
  • A variety of different outreach methods are needed to connect with providers and make sure information is accurate and up to date.

Many of the participating health plans will continue to work with our pilot vendors. In addition, other vendors will support health plans as they contact their providers and validate information included in online and hard-copy directories.

This initiative taught us many important lessons for improving provider directories – and we’re committed to making them as accurate and up-to-date as possible.

Jeanette Thornton is SVP of Health Plan Operations & Strategy at AHIP.