With hundreds of thousands of dollars in fines, millions of dollars in customer rebates and customer loyalty at risk, payers can no longer afford to manage inaccurate or inadequate provider directories, according to a new report from consulting firm IDC Health Insights.
"Customer engagement with payers starts Day One when the patient checks to determine if their set of doctors is local, in-network, available for new patients, speaks their language and is convenient," Jeff Rivkin, the company's research director for healthcare payer IT strategies, said in an announcement. The "new consumer engagement paradigm is driving payers to finally pay attention to the directory and network ecosystem," he said.
The new approach represents a sea change for payers, according to the report, who for years published paper and later online directories that were "inaccurate, out of date and generally hard to use." The bad data left plan members paying out-of-network charges or having trouble finding in-network providers accepting insurance marketplace patients, among other complications. Payers blamed providers for not updating their information, according to the executive summary.
To improve the accuracy of provider directories, Rivkin recommended payers:
- Categorize provider data, separating core directory data from operational and "quality-would-be-nice-to-have" data
- Adopt a collective non-competitive mindset, asking whether a competitive advantage is "worth the cost of doing it alone"
- Use one system of record for all provider data
- Maintain the provider data ecosystem over a multiyear timeline using a comprehensive baseline, reactive and proactive approach
To learn more:
- here's the announcement