Sarah Summer, Deputy Director, Public Policy – Blue Shield of California
Provider Directories from Consumer perspective.
2016 – 12.7M people purchased insurance through Health Insurance Exchange aka Marketplace.
Newly Insured are largely subsidized. Lower income participants.
Higher Churn than other insured populations.
- Mainly leaving for Employer plans
Challenges
- Keeping costs reasonable
- Making complex products in simple terms
- Higher rates of churn
- Government oversight and regulations
Multiple regulators sometimes in conflict.
Provider directories are important but hard to get right.
Consumers use them to choose plans.
But there is:
– Provider confusion
– Quickly changing data
– Outdated systems and processes
– Reliance on factors outside a plans control.
Data needs to be updated on weekly or monthly basis. eg. Accepting patients.
Currently using Fax to maintain information
Federal Regulations
- Qualified Health Plans
- Medicare Advantage
- Medicaid “Mega-REg”
State Regulations
- SB 137
- Covered California
- CDI Network Adequacy Regulations
- DHCS Requirements
Provider Directory Components:
- Provider Portal
- Database
- Consumer Portal
People want to fix consumer web-site first but you need to get the underlying data accurate first.
How to fix
Provider Shared Responsibility
- Carrot – make it easier
- Stick – Consequences for not updating – Contract requirements (SB137 enables withholding payment for up to 1 month)
Leverage Efficiencies
- Use Existing Sources
- Identify inconsistencies
Create a single source of Truth
- Master Database
AHIP Provider Directory initiative
- Improve accuracy
- Reduce noise
- Evaluate options
Approaches
- Consumer Search tool (Garbage in, Garbage out)
- Provider Data Federation
- **** Shared Central Provider Data Utility
Availity and Better Doctor are recommended Vendors
Currently in Pilot.
Vendor selection in Q4 2016.
Presenter: Sarah Summer
via WordPress http://2.healthca.mp/1MQdkTf
