If you’ve ever tried to use your insurer’s online directory of health care providers, there’s a good chance that you’ve been frustrated by an error or two: It says a doctor is accepting Medicare patients. Not! Or, it says an obstetrician is accepting new patients. Nope!
Such errors will significantly decline in California, leaders of a key health care industry trade group said Tuesday, if providers and health plans adopt a one-stop digital shop that the organization developed in collaboration with insurers, providers, suppliers and other key stakeholders.
The Integrated Healthcare Association announced the debut of its Symphony Provider Directory, which will allow health care practitioners to access a dashboard where they can update all their information and submit it to all insurers at one time. Insurers, on the other hand, will be able to easily import those updates for all their system providers.
“This is much more than a complex IT project,” said Dr. Jeffrey Rideout, the association’s president and chief executive. “This is an industry-wide commitment to improve the health care system in California. IHA’s role is to drive alignment and establish an effective and sustainable platform that supports the complex needs of health plans, providers and ultimately health care consumers.”
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Although Symphony is called a directory, its aggregate database will be accessible to consumers only through the health plan websites. Eyal Gurion, IHA’s senior vice president for strategic initiatives whose worked on the Symphony project for the last 18 months of his time, says he’ll continue to work to ensure the project’s successful adoption.
“The first thing we did was pretty extensive market research with all the plans and providers and purchasers that we work with to really understand what this needs to look like for this to work and add value,” Gurion said. “After building (Symphony), we worked with three of the largest plans in California – HealthNet, Anthem and Blue Shield – and roughly 6,000 providers, both provider organizations and small independent practices across the state, to make sure that (it) operates the way it should.”
Providers and insurers put Symphony through its paces in 2018, making suggestions for improvements and additions.
Errors in medical directories are common all around the United States. In fact, the U.S. Center for Medicare and Medicaid Services reviews directories for a third of its Medicare Advantage plans every year. Between November 2017 and July 2018, it found that 48.7 percent of directories had at least one error. That figure has hovered close to 50 percent over the last three years.
When consumers find errors, the report stated, they begin:
▪ To question the accuracy of the number of providers in the Medicare network.
▪ To lose trust in the integrity of Medicare administrators and the system.
▪ To worry that their care needs may not be met.
Federal officials said Medicare would study ways to encourage a collaborative industry approach to create a centralized database that all providers could update and where all plans could access information. California legislators made that idea appealing to industry in 2015 when they passed legislation requiring health plans to establish online provider directories and update the information at least once a week.
Senate Bill 137 allows insurers to terminate contracts or deny payments if, within a mandated period, a provider doesn’t respond to requests for updated information. Insurers also may face penalties if they knowingly relied upon inaccurate information for their directories.
But this isn’t solely about complying with the law for Sachin Gangupantula, who co-owns a medical practice in Modesto. It’s about ensuring that consumers know that providers are open for business, he said.
“If you look at the last three years of the Affordable Care Act and what it has done, it has introduced so many new patients into the system,” he said, “and a lot of people are coming for the first time into the health care market, and they don’t know exactly where to look for physicians or what to look for.
“If we’re not doing a good job of providing information correctly, I fear that we will just lose the patients all over again.”
After Gangupantula opened up Valley Diabetes & Obesity, he said, he was overwhelmed by how many requests he received for updated information but also how many different ways those requests came to him: Some large health plans began requiring their providers to use their online portals to update their information. Others contracted with companies that had developed online directory software that would send them updates. Many continued to rely upon faxes, U.S. mail or emails to collect information.
Gangupantula runs business operations while his wife and co-owner, Dr. Gopika Gangupantula, is the sole practitioner there. Their practice opened in March 2017, and he didn’t understand why he was so often receiving requests for updated information until he read SB 137. He assigned himself the challenge of verifying the practice’s information with insurers because he didn’t want to reduce the amount of time staff had for patient care.
He was still struggling with managing the updates when he went to an industry conference in early 2018. There, he ran into representatives from Gurion’s team at the Integrated Healthcare Association. They told him about their effort to ensure health care practitioners could update their information once and easily update it with every health plan they served.
“I said, ‘Whoa! This is exactly what I need as a small practice, and I can imagine how big of a problem it would be for a larger practice with hundreds of physicians,’ ” Gangupantula said.
He gave them his contact information and told them he would be happy to help in any way he could. They later asked him to participate in a soft launch of the software they had developed for physicians.
“I actually provided them with a lot of feedback on the functionality and the usability aspect of it, just because I have a background in engineering,” Gangupantula said. “We’ve had at least two occasions where we all came together – all of the soft launch partners as well as all of the payers. Together, we were able to talk through the entire process and what is involved and what are the best things we’ve seen so far and what we can improve.”
One such improvement, he said, was ensuring that the dashboard showed providers which health plans they contract with at each insurer. This was important, Gangupantula said, because each insurer has many products, names sound alike and so administrators might have to look up contracts for each update.
“Compare all of the confusion we have now with having one single interface available to all practices,” he said, “and it shows us, ‘Hey, here are the two contracts you have with a payer.’ It shows you the information they have on you, and if you want to change any of it, you update it. ... It’s one step, literally one portal.”
Gurion said providers and insurers will receive automated reminders or alerts when information information must be updated. Symphony will be free to providers in 2019, Gurion said, and pricing has not yet been determined for 2020. It will be based upon the number of practitioners in each group.
The online system was developed with a $50 million payment from Blue Shield of California, funds that the insurer said it would provide as part of an agreement it negotiated with the California Department of Managed Health Care to be able to acquire Care1st Health Plan.
The staff at Integrated Healthcare Association already have a large physician practice group and insurer interested in getting Symphony at their organizations, Gurion said, and professional associations and societies are standing ready to help spread the word about it. Education will be really crucial, he said, and the staff plans to lead sessions for big practice groups and at industry conferences.
“We have a pretty robust outreach and education plan,” Gurion said. “We have 100,000 physicians in California – MD’s and DO’s – but online directories include a much broader group of providers. It’s physicians. It’s behavioral health professionals. It’s dentists. Essentially everything offered through a health plan product needs to be included in the directory, and we estimate just in California, we have 200,000 to 250,000 practitioners and providers in California that need to be reached.”