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AHIP announces first-of-its-kind provider directory pilot

A pilot program will start in April and run through September in three states: Indiana, California and Florida.

Susan Morse, Senior Editor

Because more than 80 percent of consumers go to Google to find a doctor, and much of that information is inaccurate, America's Health Insurance Plans has initiated a first-of-its-kind provider directory, AHIP announced on Tuesday.

For the program to work, it requires cooperation between providers and health plans, according to AHIP President and CEO Marilyn Tavenner.

"This project builds on AHIP's continued focused on consumer experience," Tavenner said. "It is essential provider directories reflect accurate information about providers. It requires a commitment from both sides."

A pilot program will start in April and run through September in three states: Indiana, California and Florida.

Twelve health plans spanning the commercial, Medicaid, and Medicare Advantage markets are participating. They include: Anthem; AvMed; Blue Shield of California; Cigna; Florida Blue; Health Net; Humana; LA Care; Molina Healthcare of California; SCAN Health Plan; WellCare; and Western Health Advantage.

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The pilot projects in Indiana and California will have the support of vendor BetterDoctor, and in Florida, Availity. The vendors were chosen through a competitive selection process.

The vendors will proactively contact doctors for information, said Availity CEO Russ Thomas.

Each year, about 20 percent of doctors move or change practices, making current information unreliable for the 83 percent of consumers who look for a doctor on Google, according to Ari Tulla, co-founder and CEO of Better Doctor.

The current system is ineffective, illogical and unsustainable, said AvMed President and CEO Michael Gallagher.

Paul Markovich, president and CEO of Blue Shield of California is leading AHIP's task force on the pilot projects.

"It's imperative we get accurate information to consumers on their providers," Markovich said. "We recognize that it takes both providers and health plans to make this work … to provide a single stop to update this information."

Providers benefit by having one primary point of contact for inquiries for changes, rather than receiving requests from multiple health plans, AHIP said.

[Also: AHIP chief Marilyn Tavenner blasts drug plans as Hillary Clinton proposal targets price hikes]

More than 100,000 providers are estimated to take part.

Currently, health plans employ a variety of approaches to maintain and update provider directory data, including scheduled phone calls, follow-up faxes, emails, and in-person visits, according to AHIP.

These multifaceted outreach efforts are in addition to contractual requirements between health plans and providers to ensure information is accurate and up-to-date, AHIP said.

However, given the diversity of providers in health plans' networks, data can quickly become out of date. Moreover, not all providers rely on the same method of communication, AHIP said. This often leads to delays in updating pertinent provider information.

Under the pilot program, providers may be contacted by phone, email, or fax with instructions on how to update their information. BetterDoctor and Availity will then share data changes with the participating health plans to update their online and hard-copy directories.

Providers will be asked to verify items such as their location including address, phone and fax numbers, specialty, whether the practice is accepting new patients, insurance network status, and medical group and hospital affiliations.

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BetterDoctor will primarily use phone calls to validate information with providers based on aggregating all of the participating health plan data, but will also use emails driving providers to an online profile and fax outreach.

Availity will provide alerts asking providers to validate their information within Availity's existing provider portal. They will also conduct phone and email outreach directing providers to update their information within the portal which will be shared with all participating plans.

Both vendors will update information in their own centralized databases. Any updates received from providers, or non-responses, such as non-working numbers, will be shared with all participating health plans through those portals.

All participating health plans will incorporate these changes into their provider directories, though some data such as changes in provider participation in a particular health plan network may require additional follow up by the impacted health plan, AHIP said.

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The pilot programs incorporate recent regulatory changes related to network directories, including new Medicare Advantage requirements for 2016 that require quarterly outreach to providers to verify key provider directory data, AHIP said.

The pilot also reflects recent California legislation in SB 137 that requires bi-annual validation of providers' data for individual and institutional providers, as well as recent California Department of Insurance Network Adequacy Regulations.

The pilots meet federal standards for qualified health plans participating in the federal marketplace, AHIP said.

The aim is to continue the initiative on a national scale, according to AHIP's announcement.

Results from the pilots are expected in the fall of  2016, after an independent evaluation is done based on feedback from providers, health plans and consumers.
 

Twitter: @SusanJMorse

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