The normalization of machine-readable directories could usher in a new era of transparency for researchers, regulators, health plans and consumers.
The information needed to gauge measures of healthcare access, such as new patient acceptance rates, is out there, but difficult to parse, wrote Mike Adelberg, senior director at FaegreBD Consulting, and Michell Strollo, DrPH, MHS, and vice president and associate director of NORC’s Health Care Department, in a post on the Health Affairs Blog. They see machine-readable provider directories as a major element of the move toward more transparent networks.
Current efforts to compile machine-readable directories have been driven largely by requirements in the Affordable Care Act exchange markets, and will be required in Medicaid starting in 2018. The Centers for Medicare & Medicaid Services recently tightened its rules governing provider directories in response to complaints from ACA plan enrollees who had difficulties finding doctors who would accept them as patients.
Inaccuracies in provider directories represent the other major driver behind implementation of machine-readable solutions, according to the blog post. The problem has become pernicious enough to spur California and other states to pass legislation pushing providers to keep their directories accurate and up to date, as FierceHealthcare has reported.
The industry’s main trade association, America’s Health Insurance Plans, has supported a pilot program for directory checks, and other entities have begun to offer additional services that the authors believe will “improve the accuracy and transparency of provider network information in the future.”
With CMS jumping into the game and expressing a preference for “harmonizing” requirements among the programs it oversees, the authors see a strong likelihood that the technology will become normalized over time.
That, they said, could trigger a revolutionary transparency as provider networks become both more accurate and easier to measure. The ability to compare health plans across an array of public and private markets, they wrote, would “revolutionize our understanding of how health plans and regulators ensure enrollees have access to providers and needed services.”