Healthcare industry research on directory inaccuracy from Ribbon Health cited in Fierce Healthcare

By
Nate Maslak
February 26, 2020
Ribbon Health’s research on provider directory accuracy for plans on Individual Exchange Marketplaces was recently featured by Fierce Healthcare.

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.

Review our findings below.

Health plan directories for individual marketplaces are under 50% accurate, but Ribbon Health predictive analytics can help.

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