HIT Think

Why it’s time to reinvent provider directories for consumers

What do consumers want to know before choosing a doctor? Ease of appointment booking? Average wait times? Cost of services?

About 25 ago, these could all be answered through word-of-mouth referrals. While provider directories won’t capture subjective measures, they can strive to answer more of the questions consumers are currently asking.

The birth of HMOs and creation of insurance network in the 1990s led to provider directories that have become the primary source for members to find health providers. As directories have upgraded from print to online to mobile devices, they have failed to keep up with the evolution of consumer engagement in healthcare.

In current directories, information such as provider specialty, location, hours, acceptance of new patients and more make up the foundation of provider demographics. The search functions have advanced to match the proliferation of plan designs and product types. Some have included gold stars to indicate quality or network preferences. Others have rearranged the order of provider listing for various business reasons.

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The Centers for Medicare and Medicaid Services has published regulatory guidelines on directory standards. Even blockchain technology is undergoing pilots to address provider credentialing and directory accuracy. There is no shortage of effort in making provider information assessible, accurate and timely for consumers.

Even so, these initiatives only offer incremental improvements and efficiencies to business as usual operations. They have not caught up to the paradigm shift needed to improve consumer access to care, points of entry to vertically integrated care, or transparency of provider affiliation for consumers to make informed provider selection decisions.

Traditionally, payer organizations manage provider relations and activities through network management—maintaining adequate network supply, managing unit cost, and assuring quality through credentialing and assorted levels of performance benchmarks.

With the arrival of Accountable Care Organizations (ACOs) comes a variety of network configurations and insurance products where utilization steerage and quality measures are central to managing care and cost of defined populations. The lesser discussed topic is the underlying provider data management, which is essential to support the increasingly complex network relationships and contractual arrangements in the changing market dynamics.

Furthermore, as the movement to consumer-directed care continues to permeate segments of private and public products, managing provider supply has moved beyond provider-member ratio, office hours or insurance acceptance indicators. Maintaining a robust provider database has become a given.

However, the next evolution of provider data management must address questions from consumer perspectives, preferences and their decision-making paradigm. As provider choice becomes a competitive factor in selecting commercial and government funded plans, so must provider data from content relevancy, real-time and transparency aspects.

Industry disruptive forces such as Oscar Health, Lyft and Rent the Runway, have ignited the rise of consumer expectations. Decision making with real-time information for selecting and purchasing transactions are becoming presuppositions. Although this technology and data-empowered movement is making its way to healthcare, it has not yet replaced the antiquated way in which consumers semi-blindly select their care providers.

In paving the way to this reality, one must transform the provider data structure and management to provider flexibility and real-time information for which consumers can search and select the "right" providers and be informed of the downstream impact of such decisions. Provider directories are often the first point of contact for members seeking care (with emergencies the prime exception). Yet, today it remains and functions like rigid tables based on criteria that are health plan-centric and inflexible for consumer-directed care needs.

Often the shift from health plan-centric to consumer-centric starts with asking the right questions from a consumer impact point of view. For example, an improved way to address access to care can include information on average wait time (number of days) for members to successfully schedule an appointment. This not only helps to manage member expectations, but also gives deeper insight for health plans to evaluate network adequacy beyond provider counts and provider-member ratio.

Another area impacting consumer decisions is provider affiliation information. Labeling group practice name on the directory, at best, sheds information on practice size and its various locations; it does not inform consumers of provider affiliations to hospitals, ambulatory surgery centers or referral networks, all of which have direct impact to a patient's care path, cost and experience.

Furthermore, with healthcare system mergers happening across the country, with providers are aligning legally and contractually in integrated care delivery models, it is crucial for consumers to have line of sight to such changes in provider affiliation, referrals and other downstream impact to make informed decisions about provider selection.

Personalized healthcare is not one-size-fits-all, so the criteria for choosing providers shouldn't be either. Transforming provider data and its usage can benefit from collecting additional data points to accommodate consumer preference in provider search.

For example, it would be helpful to include a provider's clinical area of focus, available engagement channels (portals, phone calls, emails and the like) or quantifiable experience level (volume of diagnosis seen, or surgery performed) in the directory. With many health plans already proactively enrolling members for care management programs, directory indicators of provider participation in available programs can improve outreach effectiveness and program adherence.

Additionally, upgrading directory to include information on social service providers can raise awareness and increase usage of social programs to improve gaps in care. Even something as simple as embedding provider’s website in online directories can reduce the time consumers spent on searching for additional practice information. Having data beyond general credentialing information offers greater communication, smarter match-up and allows prioritization in consumers choosing of what's important to their universe.

Consumers are increasingly sharing the cost of care with health plans and providers alike through high deductibles, copays and coinsurance. By selecting the right providers, consumers are in better control of their care delivery, cost, and provider experience.

The primary source of provider search that exists today has not kept up with the complexity of healthcare or the consumer expectations of our time. Many are faced with choosing network providers without the transparency of downstream impact to referrals, site of care, cost or other preferences that could optimize provider match. Rethinking the structure, purpose and usage of provider data is not only necessary to support evolved care delivery models, but also critical to empowering consumers with their choosing of provider care partners.

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