On November 18, the Oakland, California-based Integrated Healthcare Association released a whitepaper, “Implementation Insights From the Inaugural year of California’s Statewide Provider Directory.” The whitepaper examined some of the insights that the leaders of the IHA, which describes itself on its website as a non-profit association that “convenes diverse stakeholders, including physician organizations, hospitals and health systems, health plans, purchasers and consumers committed to high-value integrated care that improves quality and affordability for patients across California and the nation,” have gained in evolving forward a statewide provider directory for the nation’s most populous state.
As the whitepaper noted, “Provider directories play a critical role in helping consumers navigate the healthcare system, make decisions on plan enrollment and access the care they need. Yet, consumer-facing directories are often incomplete and inaccurate, creating confusion and barriers to care. The responsibility for maintaining provider directory information largely falls on plans and providers, and the process can be costly and administratively burdensome. In California, arguably the most complex healthcare market, state legislators passed Senate Bill 137 in 2016, a comprehensive provider directory compliance law. To address industry challenges and regulatory requirements, the Symphony Provider Directory (Symphony) was launched statewide in January 2019 to help plans and providers in California to improve the quality of provider information that consumers depend on. Led by the non-profit organization, Integrated Healthcare Association (IHA), the Symphony Provider Directory is the centralized platform for provider data management in California. Though not currently consumer-facing, Symphony enables plans and providers to more easily and accurately maintain the information that consumers access through a plan’s member directory.”
As the whitepaper noted, “Key insights from the white paper
include the importance of:
• accommodating complex contractual relationships in compliance with state and federal requirements
• building a foundation of data quality metrics and facilitating data reconciliations between plans and providers
• meeting clients where they are and enabling actionable improvements and best practices over time
• accelerating growth with a strong network of participation among California’s largest healthcare entities”
With regard to the origins of this work, the whitepaper explained those origins thus:
“In 2015, in recognition of industry challenges and as a condition of the Department of Managed Healthcare’s (DMHC) approval of their acquisition of Care1st Health Plan (now Promise Health Plan), Blue Shield of California committed $50 million to establish a statewide provider directory utility. IHA was selected by a multi-stakeholder advisory committee to implement and govern the statewide directory due to its experience as a trusted convener and builder of robust, scalable data infrastructure in California. Shortly thereafter, IHA began planning efforts to design and develop the platform with the goal to roll-out starting in 2019.”
The whitepaper went on to say that, “To successfully execute the vision of centralizing provider data management and strengthening provider data quality in California, IHA engaged in a thorough assessment of the provider data management industry to find partners who could meet the strict business and technical requirements. After a comprehensive search, IHA and a multi-stakeholder committee selected two key technology partners with extensive market share in California to help build the Symphony Provider Directory—Gaine Healthcare (a software company specializing in enterprise data management) and Availity (a multi-payer platform that improves collaboration between plans and providers.)”
And it added, “IHA will continue to leverage its vast network in California to build a strong foundation and accelerate growth. The value that Symphony drives increases as participation grows: more data from plans and providers enables Symphony to provide a comprehensive view of data quality. IHA’s eventual goal is for Symphony to become self-sustainable through subscription fees paid by plans and provider organizations. Thanks to the initial grant, IHA was able to fully subsidize participation for the duration of 2019. In order to achieve sustainability, Symphony strives to onboard a critical mass of industry participation, or 50 percent of all plans and providers in California, by 2022.”
Following publication of the whitepaper, Eyal Gurion, IHA’s chief operating officer, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland about the organization’s work in this area. Below are excerpts from that interview.
Looking at the key insights noted in the whitepaper, can you share some thoughts on what you and your colleagues have been learning?
From a key insights point of view, you’re probably familiar with the California healthcare market; it is highly complex, in terms of its structure, with the delegated model. A single doctor might have contracts with 20 different health plans, and might be affiliated with a variety of IPAs and hospitals. He might be considered a PCP under IPA contract number one, and a cardiologists under IPA contract number two. And you really need to track all of that on an ongoing basis, to understand the data. So a provider director really is an ongoing target, and being able to map that data is a critical component, and focus area for us, and has been since day one.
And it’s important to have both the technology platform to support that, and also a robust program management component. So, bringing multiple stakeholders together, there are multiple workflows to be coordinated.
The foundation of data quality metrics has basically been built?
IHA’s sweet spot is really leading industry-wide initiatives, where you need all these stakeholder groups to participate. Providers can solve provider-directory data issues, plans can’t; they all need to buy into a shared infrastructure. It’s really about building a critical mass of data infrastructure. And IHA’s unique position is that we’re a trade association with 50 of the largest organizations in the state involved.
And everyone was looking at accuracy and data quality differently; every organization was using something different. In order to move the needle on data quality and accuracy, we need specific elements for data quality and accuracy. So we put in place robust data elements. Define quality for an NPI [National Provider Identification] number? For specialties? For an address? All of these data elements are different in nature, and have different policies and survivorship rules: for example, an NPI number, you have third-party sources that you can reference NPI numbers against. There are third-party sources that you can reference the data from.
And it’s not binary; it’s much more complex than that. Provider directory data is poor overall. There’s a reason that we stood up Symphony; it’s because of numbers like that, which really impact care.
And, per context, more and more plans and providers are joining Symphony on a monthly basis. And we’re getting more and more records in, records that need to be cleaned and improved.
How challenging has the work around data cleansing, clarity, and integrity, been?
That’s the difficult work that we do every day and that’s in front of us. It takes us about three to four months to onboard a large provider organization, and six to eight months to onboard a large plan, meaning, to get to a place where we’re actually exchanging data weekly in a way that works for the organization, and in a way that they can consume the data. Once an organization is fully onboarded, then, how do providers act on the data we send them? They actually need to put into place internal workflows to help them scale the data they get on a weekly basis. That’s hard work, especially for the large plans; their legacy information systems are slower. But that’s how you get to meaningful change, once they put into place their workflows, that’s when we significant improvement in data quality.
What have been the biggest challenges, and the main lessons learned so far?
Per challenges, provider data is complex and a moving target; it’s about putting into place processes in plans and provider organizations that create and keep quality in data on an ongoing basis. The main lesson learned is that you need the entire industry to engage; you need engagement from the practitioner, to the IPA or medical group, to the hospital system, to the health plan. All of those organizations need to actively participate to make it accurate. Also, we need to meet organizations where they are. If we require plans and providers to use a standard form or way of sending data to us, that won’t work; it would mean that there’s a huge barrier to entry from a provider or plan point of view. So we meet them we’re they’re at, meaning, sending us the data you have, and we’ll standardize the data on our end, on the Symphony side. Let’s work together to make meaningful improvements over time. That’s the approach we’ve taken with all the large plans and provider organizations, and it provided to be very helpful. Those are the key lessons learned, and there’s a challenge associated with each lesson learned.
Also, large health plans are complex organizations with complex decision-making processes. Having an executive sponsor providing executive sponsorship helps us bypass barriers, make decisions faster, allocate resources. This is a meaningful journey that we’re taking with all our participants. We’re resolving a debt of bad processes from the past 25 years. The change doesn’t take place overnight. But executive oversight and engagement and sponsorship have been critical. And also, alignment with both state and federal regulations is key.
The meaningful opportunity or goal for us is really to improve data for consumers and patients, but we can’t overlook the compliance element, esp. with S.B. 137 in California, a pretty stringent regulation around provider directories.
What would your advice be for others who might consider trying to initiate this kind of work?
Yes, it goes back to the fact that technology is important; you need the right algorithms, and you need best-in-class technology to solve this. But it really starts and ends with the industry coming together. If a state is considering doing something like this, you need a critical mass in communication and engagement, because that network value drives participation. And having a governance structure with people who wake up every morning and their goal and accountability is, how do I help the industry solve provider directory issues. You need a third party that helps resolves all those questions. And that’s us, in California.
And this is really hard work, but it’s also incredibly rewarding seeing competitors collaborate to improve data flow in the industry; it’s humbling, and it’s great. And even though it’s a competitive landscape, people really want to do the right thing around data-sharing.
