How an API in healthcare will transform provider directories

By
Stephanie St. Thomas
November 11, 2020

Are health plans ready for provider directory APIs?

In our latest eBook, Simplifying Healthcare Navigation, we explore how accessible provider directory data transforms patient journeys, and how innovative organizations are unlocking this necessary data by using an API in healthcare.

API in healthcare requirements and opportunities

In less than a year, the Centers for Medicare and Medicaid Services (CMS) will require CMS-regulated health plans to provide public access to provider directory data, via APIs (application programming interfaces). This rule applies to Medicare Advantage organizations and Medicaid and CHIP fee-for-service programs and managed care plans/entities.

Dr. Don Rucker, the National Coordinator for Health Information Technology, describes the change this way:


“Delivering interoperability actually gives patients the ability to manage their healthcare the same way they manage their finances, travel and every other component of their lives. This requires using modern computing standards and APIs that give patients…the ability to use the tools they want to shop for and coordinate their own care on their smartphones.”

When APIs take hold, consumers benefit

While the developer community is very familiar with APIs, they’re invisible to most consumers, who use APIs every day, when they:

  • Shop on Amazon
  • Pay someone through PayPal
  • Plan a vacation on a travel website
  • Use an online budgeting tool

APIs drive every one of these interactions, and many more, by enabling websites to share applications developed by third-party companies. Your Amazon purchase may have been processed by Stripe, and your bank’s new budgeting tool could be Yodlee.

All of these consumer experiences used to require more time and energy spent on paperwork, telephone calls to gatekeepers, and in-person appointments or shopping trips. With APIs, information has become a trusted utility: always there, whenever and however needed—as fundamental as electricity or water.

Provider data problems create barriers to finding care

For consumers, the healthcare experience is still opaque and frustrating, whenever information is involved:

Will a doctor accept my health plan?

Are there any physical therapists near my home?

How do I find a specialist with the right clinical expertise to help my loved one?

Can I schedule a medical appointment on my smartphone?

Is provider directory data ready for transparency?

Many of these questions tie back to the quality and availability of provider data. Nearly half of provider data is inaccurate, as documented in numerous audits by CMS, and experienced on a daily basis by consumers, healthcare providers, and health plans. That leaves the industry with a conundrum: builders of APIs are ready to take on provider data, but the data isn’t ready to be exposed through APIs.

Can provider directory APIs become an opportunity?

Ribbon Health believes that high-quality provider data can transform the consumer healthcare experience. Ribbon customer organizations are accessing a national provider reference database of the highest quality and accuracy and using it to strengthen their existing provider data, as they prepare to introduce provider directory APIs. Our team is expert in APIs and ready to assist our customers through this industry-wide transition.

With access to higher-quality data, our customers are already:

  • Ensuring that it’s easier for patients and health plan members to find in-network care, including highly-specialized providers
  • Equipping care navigators with comprehensive, real-time data, so they provide timely, informed referrals and can guide patients to the right form of care
  • Introducing access to provider directory data through new channels, such as virtual care

Learn more about how APIs and high-quality provider data support patient journeys and build consumer loyalty.

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