People today are accustomed to using the internet to find every product and service they need, including healthcare providers. Patients are 1.7x more likely to use online sources to find a doctor than they are referrals from friends and family. As the world becomes increasingly digital, online resources, such as health plan provider directories, are how patients find an in-network physician, specialist, or facility.
The problem is the administrative burden associated with maintaining provider directories has become untenable. $2.76 billion are wasted every year on provider directory maintenance, with the main culprit being unreliable provider data – though inconsistent formats and technologies and the near-constant flow of requests also impact that figure.
As a result, provider directories are filled with inaccurate and incomplete data, causing delayed access to care and surprise medical bills. And with federal and state legislators taking steps to hold health plans accountable for improperly maintaining directory data, providers face another time-consuming administrative process.
The Impact of Unreliable Directory Data
Too often, issues with provider directories trickle down to patient care, causing financial and health problems that can be catastrophic. While ensuring a provider directory is entirely accurate all the time is nearly impossible, unreliable directory management inconveniences users and directly impacts costs and access to valuable care.
A recent Senate committee study shined a light on just how bad the provider data management problem is. The report discovered that 80% of listed mental health providers in directories were unreachable, not accepting new patients or not-in-network. This is not a sustainable solution to health care – patients will stop seeking treatment for non-emergency care if discouraged, which will ultimately overcrowd emergency rooms.
Regulations, automation, and emerging technology can – and must – curb these challenges and guarantee patients quality, affordable care. To meet the moment, health plans and providers need a modern solution that streamlines provider directory management, transforming healthcare delivery through data and interoperability using solutions that contribute to significant cost savings, increased accuracy and efficiency, and ultimately, more accessible and better quality patient care.
The Challenge of Directory Maintenance
Provider directories are meant to be helpful resources for patients, providers, and health plans. First, understanding the challenges that make them so complicated and expensive to maintain is essential to solving the problem. These challenges include the following:
- Constant information changes: A provider’s information, including location, specialties, phone number, or network affiliation, can change frequently. In fact, the AMA reports that 20% to 30% of directory information updates annually, making it hard for health plans to keep an up-to-date provider directory at all times.
- Inaccurate and incomplete data: From verifying provider credentials to ensuring data is entered properly and kept up to date, maintaining accurate data in provider directories is challenging and time-consuming. Furthermore, provider directories often miss information or have a limited network of providers, which makes it difficult for patients to find providers who are covered under their insurance plan.
- Lack of standardization: On average, the typical practice is associated with over 20 different health plan contacts through various platforms, formats, and timelines.There is no uniformity to the frequency or format in which providers must share data, with providers submitting directory information by fax, credentialing software, email, provider management and enrollment software, phone, mail, and other methods.
- Non-compliant records: Currently, directories rarely have reporting or analytical capabilities that make it possible to identify non-compliant records in provider directories.
- Data volume: With increasing regulation, providers are increasingly concerned with maintaining compliance, causing them to submit frequent data updates that overwhelm the health plans managing the directories.
Ensuring Provider Directory Accuracy
When a healthcare provider joins a health plan network, they usually submit contact information, academic qualifications, and practice location to populate the provider directory. Should their information change, however, the provider and health plan collaborate and update provider directories with the new data, which takes time and effort.
Patients often do not have the luxury of waiting for care. When they are seeking service through a health plan, they rely on providers who meet their individual needs and preferences, such as location, specialty, and costs. When provider data is inaccurate in online directories, patients wind up with costly medical bills that can disrupt care entirely.
On January 1, 2023 the No Surprises Act was implemented to increase data accuracy in Medicare and Medicaid plans. This recent regulation change requires health plans to confirm or attest provider data every 90 days to ensure directory updates appear searchable for customers within 48 hours of being notified of a provider information change. Without data standards and automation, ensuring this regulation can be extremely difficult to implement and uphold.
There have been increasing calls for a single national directory to reduce the complexity of provider directories and protect patients. A study from the Council of Affordable Quality Healthcare (CAQH) even estimated that collecting directory data in a single platform could save physicians $1.1 billion in annual administrative costs. No such plan is in place, with many health systems lacking the technology necessary to support a move to a single provider directory.
With health plans still responsible for maintaining directories, solutions that eliminate data silos, establish a standard process, and automate directory maintenance are more important than ever. Embracing data management platforms that can centralize the countless data points exchanged between providers, payers, and their partners will reduce the burden on providers while improving the accuracy of directories for all parties involved.
Eric Demers is the CEO of Madaket Health. He believes we can transform healthcare delivery through the power of data and interoperability. With more than 25 years of global healthcare experience, Eric has built and scaled leading technology and service companies, from early stage to Fortune 100. He is highly sought-after for speaking and consulting on international health, having advised global entities and governments on critical issues facing healthcare. A growth-minded leader, Eric has founded three companies and exited two. Eric previously served in strategy-focused executive roles at IBM, Accreon, MEDecision and Orion Health. He is a graduate of Brandeis University and The George Washington University School of Medicine and Health Sciences.