by Alicia Caramencio
March 9, 2017
Consumers rely on the information they receive from health plan provider directories, and plans strive to ensure this information is up to date. Health plans depend on doctors to submit accurate and up-to-date information on details like provider and facility names, addresses, telephone numbers, and languages spoken. And it is critical that doctors reach out to health plans when their information changes and that health plans make the updates in a timely manner.
To help improve these directories, AHIP last year conducted a provider directory initiative across three states and with the participation of more than a dozen health plans. The initiative focused on how plans and doctors can work together more effectively to ensure information is timely and accurate for the people we both serve.
Key Findings and Potential Solutions
During the pilot, we worked with two vendors to contact over 160,000 providers, testing different ways to coordinate with them to update key directory data. According to an independent evaluation from NORC at the University of Chicago, the results show a need for increased awareness among providers about how important it is to update their data with the health plans. Results also indicate a need for new incentives for providers to remain accountable, and a need for additional technical standards to improve communications between health plans and providers.
A few possible solutions were identified. First, the NORC evaluation suggests health plans leverage contractual requirements and provide other incentives for keeping that data up to date.
Second, AHIP learned it is important for health plans to be flexible in how they gather information. No one outreach channel works best for all providers. Health plans should use numerous channels to connect with providers – a mix of phone calls, faxes, other notifications and emails – and modify their approach on an ongoing basis.
For example, participating vendor Availity guided providers to a directory validation form through an online portal. Providers received a notification on a system they already use for other important tasks. By catching providers within their existing workflow, validation was done much more quickly and effectively with over 786,000 data elements updated.
Another participating vendor in San Francisco, Better Doctor, connected with providers via multiple outreach channels on a quarterly basis including phone, email, and fax, and reduced provider burden by more than 16,000 hours by allowing providers to go to one source to update their data with multiple health plans.
AHIP’s provider directory initiative highlighted the complexity of maintaining accurate and up-to-date provider directories. AHIP will continue to work with providers and others across the health care industry to find new solutions for improving information for consumers.