@wcsanders @bjdickmayhew found out that the community health center in Concrete WA is labeled multiple ways on WA exchange provider search
— rebeccastob (@rebeccastob) November 2, 2016
Rebecca is an actuary and a health policy nerd who has been extremely helpful to me during many Twitter conversations. She is identifying a very legitimate problem of directories. who owns the source of truth?
Right now, providers own their data. They decide what they call their practice, they decide what address format they submit. They decide if they are taking new patients, they decide what their hours are. The providers then supply that data to the different carriers that they contract with. They also supply that data to a number of third party web display vendors. The downstream entitities can correct for obvious errors like a four digit zip code or a street address that was fat fingered and placed the office location in the middle of an Army Corps of Engineers’ lake. But the insurers don’t own the data.
Some regions will have a common sheet for the carrier to fill out, most regions have a variety of sheets or data entry screens for the carrier to complete. This is where there are significant problems.
A low level staffer could be told to complete the office profile for eight insurers by the end of the week. The office thinks they are doing well as they are engaged in a timely data refresh and revalidation cycle. This is an improvement over letting the data sit for three to ten years and seeing half the original practice working on their golf swing in Florida during their well earned retirement. But it is flawed.
123 Main Street is a legitimate address.
Suite 500, Big City Medical Commons is the same location with a wildly different descriptor.
Main and Elm Streets, NE Corner is also the same location.
123 North Main Street is also the same location.
No one owns the data validation and data consolidation step. These are all valid addresses/locations. Some are in a more preferred format than others but the postal service will deliver mail to all of these locations especially if there is a valid and relevant zip code attached.
AHIP, the insurance industry group/lobby, is playing around with a single source of truth portal in half a dozen states so that providers enter their data in a single location, that single location curates and validates the data, and then the single location serves it out to the relevant insurance companies. This would be a significant improvement. The Center for Medicare and Medicaid Services (CMS) is cracking down hard on bad directories and more importantly, out of date directories. There is effort to get better data out there for people to use. As we see a proliferation of high deductible plans along with narrow networks tied to plan designs that do not give out of network benefits, the data has to be better.
We’re not there yet.