Provider Directory Management

The complex provider data problem

For health plans and providers, maintaining provider directories is challenging, expensive, and time-consuming. 

• Each year, an estimated $2.1 billion is spent nationally by plans and providers to maintain provider databases. ¹
• On average, providers contract with 12 health plans, each of which may reach out quarterly to validate provider data.²
• 49% of online provider directories for Medicare Advantage organizations had at least one inaccuracy.³

Improving provider data in California with Symphony

In 2016, state legislators passed Senate Bill 137 (SB 137), a comprehensive provider directory compliance law. SB 137 outlines requirements for publishing and maintaining accurate provider directory information based on uniform data standards.

To address industry challenges and regulatory requirements, a group including Blue Shield of California and the Department of Managed Healthcare chose IHA to lead the creation of a statewide, centralized provider directory database.

So now, we’re orchestrating an industry-wide movement to solve provider directory challenges with the Symphony Provider Directory.

Learn more about Symphony

Our path to a statewide directory

Creating a solution to a decades-long, industry-wide issue like provider data management takes time. Follow along as we work together with health plans, providers, and industry leaders to simplify provider data management for all.

• October 2015: DMHC approves Blue Shield’s acquisition of Care1st Health Plan, requiring Blue Shield to invest $200M in programs that strengthen the healthcare delivery system in California, including the development of a statewide, centralized provider directory database.
• July 2016: SB 137 goes into effect, requiring providers to regularly attest to the accuracy of their data.
• October 2017: DMHC and Blue Shield collaborate to guide a multi-stakeholder process identifying potential organizations to host the utility, ultimately selecting IHA to lead the creation of Symphony.
• August 2018: Symphony soft launches with participants from three of the largest health plans in California (Anthem Blue Cross, Health Net, and Blue Shield of California), two large provider organizations (Hill Physicians, GlobalCare), and ten independent practices across the state.
• January 2019: Health plans and provider organizations across the state are invited to join the Symphony Provider Directory.
• October 2019: Almost a year after the directory launches, 10 health plans and more than 90 provider organizations are onboarding with Symphony.
• September 2020: As we continue to expand across California, 14 health plans and 95+ provider organizations join us on our journey.
• 2020 and Beyond: IHA is currently working to onboard current clients while also optimizing the Symphony Provider Directory experience for future audiences.

Citations

1. Issue Brief: Administrative Provider Data. CAQH [Analysis completed by Booz & Co., now Strategy&, Inc.] (December 2011)
2. Reducing Administrative Costs and Improving the Health Care System. New England Journal of Medicine (November 2012)
3.  Provider Directory Review Industry Report. CMS (July 2018)