LOS ANGELES—Inaccurate and out-of-date health plan provider directories continue to be a vexing problem in healthcare and can make it difficult for patients to find a clinician when they need care.
It's not only an inconvenience for patients but can lead to administrative burdens for providers and health plans and may impact costs and access to care.
Humana tapped data automation company Veda to improve the accuracy of its provider information and ensure seniors have real-time details about in-network providers. The partnership was announced at the ViVE 2024 conference Monday morning.
Maintaining up-to-date provider directories, including accurate phone numbers, addresses and panel status of in-network practitioners, is critical to helping seniors make informed choices about their healthcare.
Historically, Humana was making millions of calls annually to confirm provider data, but ongoing inconsistencies and inaccuracies in these directories can be a barrier to care.
Founded in 2015, Veda developed an AI platform that enables payers to transform and ingest provider rosters rapidly, reducing turnaround times from weeks to hours, according to the company.
Veda will use its patented automation technology to analyze, verify and standardize Humana’s data to ensure the information is accurate and comprehensive, along with real-time scoring of data quality.
“Accurate provider data is a key component of efficient health plan operations, care delivery, interoperability, and ultimately patient satisfaction,” Meghan Gaffney, Veda co-founder and CEO, said. “By addressing the challenges that members may face with finding in-network care providers, Humana is ensuring their members have access to the timely, high-quality care they deserve.”
Veda says its platform achieves high data accuracy, ensuring quality across networks as measured by the Centers for Medicare & Medicaid Services (CMS).
“We want to be a partner with CMS and policymakers in improving the accuracy of provider directories. This collaboration with Veda will enhance not only the experience for our members, but also our provider community,” Robbie Tindall, vice president, provider process network operations at Humana, said in a statement “We’re committed to delivering an exceptional experience for both, ultimately improving health outcomes and enhancing the overall well-being of our members.”
As part of the No Surprises Act, which went into effect two years ago, health plans are required to conduct an attestation process every 90 days to verify that their provider directories are correct. Whenever providers communicate a change affecting their directory data, the payer must correct the information within two days of receiving the provider’s notification.
Inaccurate provider lists can be a big pain point for doctors. A secret shopper study conducted by the Senate Finance Committee last year found widespread problems with inaccurate provider directories among Medicare Advantage plans. In phone calls to a sample of 120 provider listings across 12 different health plans, 33% were inaccurate, had nonworking numbers or had unreturned calls. Senator Ron Wyden’s study found that appointments were available only 18% of the time.
A secret shopper study published in JAMA Dermatology in 2014 found that only 26.6% of the individual directory listings for dermatologists in a subset of Medicare Advantage plans were unique, accepting the patient’s insurance and offering a medical dermatology appointment.
The American Medical Association also fielded a survey between 2017 and 2018 where 52% of physicians reported that their patients encountered coverage issues due to inaccurate information in provider directories at least once per month.
In October, CMS put out a request for information on a proposed CMS-led national directory of providers and services.
Humana says it has also long supported efforts to create a National Directory of Healthcare Providers and Services and has provided feedback to CMS about how such a national effort can increase patient satisfaction.