Flawed con­sumer di­rec­to­ries ‘in­ex­cus­able’

Modern Healthcare - - NEWS - By Dar­ius Tahir

As in­sur­ers face grow­ing crit­i­cism for giv­ing con­sumers in­ac­cu­rate in­for­ma­tion about their provider net­works, some ex­perts are ask­ing whether it’s re­ally that hard to main­tain an ac­cu­rate provider di­rec­tory.

The bad in­for­ma­tion has drawn lashes from Cal­i­for­nia reg­u­la­tors and pro­pos­als for stricter over­sight from the na­tion’s in­surance com­mis­sion­ers and the Obama ad­min­is­tra­tion. Good provider di­rec­to­ries are crit­i­cal as mil­lions of Americans choose health plans on the Oba­macare ex­changes. Con­sumer ad­vo­cates say shop­pers must be able to ex­am­ine their provider choices in cheaper nar­row-net­work plans.

In­sur­ers and con­sul­tants blame soft­ware prob­lems, fail­ure by providers to send up­dated in­for­ma­tion and the sheer dif­fi­culty of track­ing thou­sands of doc­tors. There are “dozens of plans with dozens of dif­fer­ent net­works,” said Dan Schuyler, se­nior di­rec­tor of ex­change tech­nol­ogy at Leav­itt Part­ners. “It’s very dif­fi­cult to keep th­ese provider di­rec­to­ries up­dated, cer­tainly on a daily ba­sis.”

A spokes­woman for Amer­ica’s Health In­surance Plans said that ac­cu­rate di­rec­to­ries are a “shared re­spon­si­bil­ity” and providers of­ten “just aren’t pro­vid­ing in­for­ma­tion in a timely man­ner.”

Josh Nel­son, a vice pres­i­dent at Arches Health Plan in Salt Lake City, said the company’s soft­ware dif­fer­en­ti­ates doc­tors by tax ID num­ber but doc­tors of­ten use the same num­ber across dif­fer­ent prac­tices. “There are a lot of car­di­ol­o­gists in the Salt Lake Val­ley,” Nel­son said. “We don’t want them all. But if we choose those few that op­er­ate in Park City, the sys­tem en­ters all the lo­ca­tions they prac­tice in. It de­feats the pur­pose of a nar­row net­work.”

That has some ex­perts scoff­ing. “Th­ese ex­pla­na­tions are out­ra­geous,” said veteran health­care con­sul­tant Robert Laszewski. “Not hav­ing ac­cu­rate con­sumer-level in­for­ma­tion about just who is in their provider net­work—par­tic­u­larly when they are us­ing nar­row net­works— is in­ex­cus­able.”

The Na­tional As­so­ci­a­tion of In­surance Com­mis­sion­ers re­cently re­vised its model law for states to re­quire that plans up­date their provider di­rec­to­ries at least monthly. HHS has pro­posed re­quir­ing in­sur­ers sell­ing plans on the ex­changes to in­di­cate whether providers in their net­work are ac­cept­ing new pa­tients.

Lynn Quincy of Con­sumers Union said the ex­changes them­selves need to of­fer tools to en­able con­sumers to read­ily com­pare provider net­works when they are shop­ping for a plan. But Schuyler said such choice tools are tricky to set up be­cause in­sur­ers have dif­fer­ent ways of list­ing providers. HHS has pro­posed that plans post their provider di­rec­to­ries in “ma­chineread­able” files so that out­side or­ga­ni­za­tions can cre­ate com­par­i­son tools for con­sumers.

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