In an Industry Voices op ed, Brian Hoyt – Managing Director at Berkeley Research Group – discusses the significant challenges health plans and patients face due to inaccurate provider directories. The article cites healthcare industry research from a Ribbon Health study demonstrating that provider directories for plans on the Individual Exchange are under 50% accurate and highlights the drivers of the industry epidemic. Specifically, Hoyt writes:
Just how (in)accurate are provider directories? The Centers for Medicare & Medicaid Services (CMS) recently released the results of its third round of annual review of the Medicare Advantage Organizations (MAOs) provider directories; the results were better than the second round, but the bar was low. Close to 49% of provider locations had at least one error in them, and “inaccuracies with the highest likelihood of preventing access to care were found in 41.75% of all locations.”
Starting in 2017, Qualified Health Plans were required to make their directories available in machine-readable format, dubbed “public use files”—or PUF—by CMS. These files were thought to “increase transparency by allowing … software developers to access provider data and create innovative and informative tools to assist customers in understanding plans’ provider networks.” A noble intent, to be sure; however, when one considers the results of a recent poll of PUF accuracy conducted by Ribbon Health, these directories are even less accurate than those for MAOs.
We at Ribbon Health believe that data aggregation, predictive analytics, and a centralized repository of accurate data will help drive the solution and provide patients with simpler and more convenient access to care.