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Why a national solution is needed for provider directories


A national solution is needed when it comes to collection and quality of provider information, according to panelists speaking at the eHealth Initiatives annual conference on Thursday.

Currently, the healthcare industry is struggling to optimize efforts to collect provider data and ensure the information is accurate, Atul Pathiyal, managing director of the Council for Affordable Quality Healthcare, said at the Washington, D.C., event.

The other speakers on the panel, Tim Kaja, senior vice president of UnitedHealth Group, and Mary Ann Yeager, CEO of the The Sequoia Project, agreed with Pathiyal.  

Kaja noted the need for clean data, something he said is critical for payers.

"You can call out every month to physician practices and talk to whoever you talk to in the office, but I can guarantee you that the data that comes back will end up with somewhere between a 20 and 25 percent error rate, because it depends on who you talk to, it depends who fills out that form," he said.

There also are a number of headwinds the industry faces when it comes to provider data, Pathiyal said, adding that they are "creating a sense of urgency for us to address this challenge."

Those headwinds, he said, include a need to keep costs down and a need to innovate and deliver new reimbursement models.

Penalties also are something insurers need to consider when it comes to provider directories. Last March, the Centers for Medicare & Medicaid Services announced that payers must provide up-to-date doctor lists for their Medicare Advantage and Healthcare.gov policies.

That announcement came in the wake of reports received by CMS that many Affordable Care Act plan enrollees struggled to find doctors who would accept them as patients.

Yeager said a national provider directory is especially important for her organization, which advocates for nation-wide health information exchange.

"We need to … facilitate electronic communication in a manner that is both trusted and between and within providers and payer networks," she said.

Currently, she added, there really is no "clear national strategy around provider directories."

"There's sort of a call out in the HELP bill draft language," she said. "But we don't have a national strategy--'Should it be federated? Should it be a single data source? What are the policies around it?' Where is the strategy? And I think that's the conversation we should be having."

"Nobody's talking about the harder stuff, and that is: How do we make this scale and truly get that broader connectivity?"

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