What is the Symphony Provider Directory?
The Symphony Provider Directory is a centralized, statewide cloud-based technology platform for providers and health plans that will serve as a single source for provider directory data such as demographics, services, products and networks.
Symphony will help maintain up-to-date, accurate, on-demand data about provider participation within health plan networks in California while lowering the administrative burden for plans and providers, making it easier to meet regulatory and business requirements, and ultimately helping consumers to find the right providers and select the right health plan.
What problem is the Symphony Provider Directory solving?
Maintaining up-to-date information about provider participation in health plan networks has been a long-standing challenge. The Affordable Care Act magnified this issue as more consumers made health care coverage decisions based on inaccurate provider data.
The current system of data collection is fragmented, duplicative and wasteful, contributing to a staggering $361 billion in healthcare administration costs annually in the U.S. And the information is often still not accurate. Symphony will support both health plan and provider needs by delivering accurate information, validating, verifying, and reconciling data, lowering provider directory management costs, and supporting compliance with SB 137*, Medicare and Medi-Cal requirements.
*SB 137 refers to Senate Bill No. 137 and regulates health plans to take appropriate steps to ensure their provider directory information is up to date and accurate.
How will health plans and providers use the Symphony Provider Directory?
Symphony is a technology platform from which all health plans can pull verified and validated provider data to populate their online directories. Provider organizations will use Symphony to receive extracts of their data for verification or editing, and independent practices will make edits directly in the portal. Providers will not need to send data in different formats to each plan and they will not need to answer multiple requests from different plans to update their data.
Is the Symphony Provider Directory a consumer-facing tool?
No, at this point Symphony is not consumer-facing, as our top priority is to improve the quality of each health plan’s provider information. Symphony is the back-end database that will consolidate and reconcile provider data and send it back to plans and other multi-plan directories to populate their consumer-facing provider directories.
How does the Symphony Provider Directory help patients?
Consumers rely on provider directories when making decisions about which plan to choose, which providers to see, and even where to go for their appointments. Inaccurate provider directories are one of the biggest pain points for patients making healthcare decisions—costing time, money, and even potentially impacting health outcomes. Symphony will help to ensure that health plans are able to consistently deliver accurate information to consumers in an efficient and cost-effective manner.
How did this initiative start and who is funding the Symphony Provider Directory?
As part of the California Department of Managed Health Care’s (DMHC) approval of Blue Shield’s 2015 acquisition of Care1st Health Plan, Blue Shield committed to investing $200M in programs that strengthen the healthcare delivery system in California, including the development of a statewide, centralized provider directory database.
While BlueShield is providing initial funding of $50M for the initiative, the goal is for Symphony Provider Directory to become a financially self-sustaining initiative by 2023. To encourage initial participation, we will be subsidizing the cost for any plan or provider organization that joins in 2019 (through the end of the year).
Why is Integrated Healthcare Association (IHA) leading this effort?
Recognizing that stakeholder engagement is critical to the success of this initiative, in 2016, the California Department of Managed Health Care (DMHC) and Blue Shield collaborated to guide a multi-stakeholder process that identified organizations that might host the utility. After a Request of Information and round of interviews with several potential organizations, the advisory committee selected IHA as the host to lead the creation of the Symphony Provider Directory.
How were the scope, governance and requirements for the Symphony Provider Directory initiative determined?
The selection process mentioned above resulted in the creation of the California Provider Directory Summit and a multi-stakeholder advisory committee of health plans, providers, consumer groups and regulators in 2016. This group worked to define priorities, functions and governance requirements for the statewide provider directory, and to evaluate organizations as potential hosts for this vital resource.
If you are interested in reviewing detailed information about the Symphony Provider Directory requirements, etc., the deliverables from these work groups are publicly available here.
How did you select the Symphony Provider Directory technology vendor(s)?
To select a technology partner for this initiative, IHA canvassed the provider data management industry and reviewed more than 15 companies to select the final three vendors who were evaluated by internal committees, with oversight from industry leaders and IHA’s executive committee.
Potential technology vendors were assessed for technology, usability, price, industry reputation, customer support capabilities and meaningful market traction in California, which resulted in the selection of Gaine Healthcare’s market-leading health plan-focused technology, and Availity’s provider organizations-focused platform. The final result of this partnership? A centralized, standardized platform for provider information in California that pulls from the best of both worlds.
Why did you select Gaine Healthcare/Availity as the Symphony Provider Directory technology vendor?
We selected Gaine Healthcare/Availity due to their ability to meet the business and technical requirements, their extensive experience in provider data management in California, and their ability to support IHA’s business plan.
The selection was made through a thorough canvass of the industry and market reviewed by internal and external committees; with oversight and final decision-making from IHA’s Executive Committee. We looked not only at the vendor’s technology, usability, price, and industry reputation, but also for strong customer support capabilities and meaningful market traction in California.
Why are both Gaine Healthcare and Availity supporting the Symphony Provider Directory?
Vendors invited to submit an RFP were allowed to partner in order to meet all business and technical requirements. The two companies together offer complementary provider data management solutions and work to connect providers, provider organizations, and health plans. Together, they will make the Symphony Provider Directory more effective for all stakeholders.
What are Gaine Healthcare/Availity’s responsibilities as the technology vendor?
Gaine Healthcare/Availity are responsible for developing and supporting the technology and product. Gaine Healthcare/Availity will partner with IHA to build a product that will address the many different types of users in California and will provide extensive customer and technical support to help users adopt this new technology and provider directory data management process.
Is the Gaine Healthcare/Availity technology best-in-class?
We have and will continue to make it a top priority to review all available technologies. We will continue to look at applications for blockchain, AI, crowdsourcing, and other established and emerging technologies to ensure that Symphony uses the right technology to continue to innovate and improve the quality and management of provider, encounter and other types of data.
Will the Symphony Provider Directory replace all existing vendors in California?
Collaboration among vendors, health plans, health systems and providers is key to successfully solving this industry-wide problem. The Symphony Provider Directory expects to work with vendors who are also addressing this need. Symphony will be a central “source of truth” for provider and provider-plan data.
COMPLIANCE AND ACCURACY
If a health plan is using the Symphony Provider Directory, will this guarantee compliance with SB 137 and other regulations? What are the roles and responsibilities for health plans, providers and Symphony in terms of meeting compliance?
While Symphony will not handle the full scope of what is required for compliance, it will make it easier to achieve compliance with SB 137, Medicare Advantage, and Medi-Cal requirements.
The Symphony Provider Directory will take on significant parts of the provider data management process for plans and providers—effectively removing the needs for those internal workflow processes—but plans will continue to be responsible for achieving full compliance for the parts of the process that Symphony does not cover. (i.e. plans are responsible for using the data from Symphony to populate their own online consumer-facing directories, etc).
How will the Symphony Provider Directory ensure that providers maintain their information?
The Symphony Provider Directory will significantly improve providers’ efficiency as they will update all plan information in one place at one time.
We plan to launch education and outreach campaigns to help providers understand what they need to submit and by when so that their processes are ultimately streamlined, and they do not get inundated with requests for their information. Consistent education and outreach will be essential to help providers understand what is needed and how to use Symphony to save time and resources.
What will the Symphony Provider Directory do if providers who need to update their data do not respond?
The Symphony Provider Directory will make several attempts to contact non-responsive providers. If a provider is non-responsive after exercising all of Symphony’s outreach processes, the Symphony Provider Directory will provide an auditable trail of every interaction and flag these providers so that the plans can take the necessary steps required by SB 137 or other regulatory requirements.
Will the Symphony Provider Directory validate health plan network information?
The Symphony Provider Directory will validate and verify provider data, including which providers are in which networks. If conflicting data exist, Symphony will notify plans and providers and work with both to resolve the conflicts.
Will the Symphony Provider Directory also collect and reconcile data for credentialing, Health Information Exchanges or All Payer Claims Databases?
No, not during the initial phase of Symphony’s development. Although we recognize that the core provider data set is consistent across multiple use cases such as credentialing, the initial launch will focus on the data for plan’s consumer-facing provider directories (i.e. practice location, products accepted, and whether or not providers are accepting new patients).
We anticipate that we will expand the capabilities of Symphony in the future, but to be successful, we are limiting the initial scope and focusing on providing accurate provider data first.
LAUNCH AND PARTICIPATION
When will the Symphony Provider Directory be available to all plans and providers in California?
The Symphony Provider Directory soft launched in August 2018 with participants from three of the largest health plans in California. There will be an “early access” launch in January 2019, with a full launch a few months later.
Who participated in the soft launch?
The three health plan participants are Anthem Blue Cross, Health Net, and Blue Shield of California and the two large provider organization participants are Hill Physicians and GlobalCare. Ten independent practices across the state were also active participants in the soft launch.
What was the role of the participants in the soft launch phase?
The goal of the soft launch was to test the technology platform, establish baseline data around data accuracy and gather feedback to improve the functionality and user experience. We also focused on optimizing the data exchange process between plans and providers from both organizations and independent practices.
What provider types are in scope for launch of the Symphony Provider Directory?
At our broad launch in early 2019, we anticipate that our participating base will include at least seven major health plans and 61 provider organizations for a total of 80k physicians and facilities across 41 counties. Participating plans include Blue Shield, Anthem, Health Net, Molina, Kern Family Health, Community Health Group, and Aetna.
We aim to achieve a critical mass of participation (at least 80% of plans and providers in CA) by 2023 to make the Symphony Provider Directory self-sustainable and truly effective as the official statewide utility for plans and providers.
How can I find out more about the Symphony Provider Directory?
To stay informed, enter your email address at the bottom of this page to receive our updates. In addition, see our News & Events page to find out where IHA will present at conferences throughout the year. If you’d like to speak to a sales rep or submit a general inquiry, you can do so on our Contact Us form.
How can my organization sign up for the Symphony Provider Directory?
Please use our Contact Us form to contact a sales rep who can provide a needs assessment or answer your questions about Symphony.