Building Consensus in Provider Data Transformation

Last month, new research about provider directories conducted by the University of Colorado and HiLabs was published in BMC Health Services Research. It leveraged HiLabs’ AI algorithms to compare data for >40% of US physicians across five large health plan directories. Like other studies before it, including our previous research published in JAMA, it highlights the magnitude of the problem with provider directory accuracy. 

The debate that took place in June at the California State Standing Committee on Health is an example of the many forums, in which providers, payers, patients, and regulators are fiercely offering their views on how to approach this challenge. Despite the contentiousness of the issue, there is agreement on the following points:  

• There is holistic agreement that the current state of directory accuracy constitutes a problem, and accurate provider directories are crucial for ensuring that patients can find and access healthcare providers when needed.  

• A continual weakness is the communication and data exchange between providers and health plans. Providers often face burdensome and repetitive processes to update their information with multiple health plans. Health plans, in turn, rely on manual processes to standardize that data.  

• There is an understanding that maintaining accurate provider directories is a shared responsibility between health plans and providers. Providers must update their information, and health plans must ensure that their directories reflect these updates accurately. 

• Stakeholders, including legislators, agree on the need for collaboration between health plans, providers, and other relevant parties to solve the issue. This includes finding technical solutions that streamline updating and maintaining directories that will improve accuracy across the industry. 

• Despite the debate on the specific solutions proposed, there is a shared understanding that the ecosystem will continue to innovate and improve the current system.  

Where do we go from here

Collectively, these points can be used as building blocks that allow the industry to move forward. They also point to a promising solution: AI technology. AI methods can fix provider directories at scale, provide transparency, and streamline communication. It can remove inefficiencies from manual tasks that burden providers, payers, and regulators so the entire industry can proactively think about getting patients the right care. They can remove inefficiencies from manual tasks that burden providers, payers, and regulators so the entire industry can proactively think about getting patients the right care.

At HiLabs, we are excited to use our collaborative approach and proven technology to solve this problem. We have seen firsthand from our health plan partners the results technology can achieve. As our technology evolves, so will its impact, and it will bring about the much-needed changes that have eluded the industry thus far.  

 If you are interested in seeing the impact technology can have on provider directory accuracy, contact us today.