Although we have seen an increase in provider outreach, data reconciliation efforts, and attestation requirements in response to state and federal regulatory requirements, data quality in health plan directories has remained inconsistent.
Creation of the Symphony Provider Directory was driven by cross-industry collaboration to help address these challenges.
Together, we are creating a centralized platform that will reduce costs and increases data quality by enabling plans, providers and regulators in California to share and reconcile information in a way that supports complex contractual relationships.
DID YOU KNOW
$2.1 billion is spent per year by commercial health insurers to maintain provider databases.
$25,000 is the fine per error per physician that plans face if they fail to keep their member directories updated.
49% of online provider directories for Medicare Advantage Organizations had at least one inaccuracy. (2018 CMS Report)
Driving standardization in data collection and management
Symphony was developed with guidance from stakeholders across the industry to ensure it would be a useful tool for health plans and provider organizations. In fact, regulators are monitoring our progress closely as they prepare to update uniform data standards and compliance requirements.
As the official statewide utility, Symphony will help to drive alignment across the industry, leading to improved data quality and, ultimately, better information for patients in health plan directories.
Improving communication between plans and providers
Symphony is designed to reduce provider and plan fatigue by streamlining duplicative processes and relieving the administrative burden of collecting and validating this information.
We leverage primary sources to automate information verification, leading to higher data quality and a more efficient data management process. Where there are conflicts in the data, we help facilitate transparent communications between plans and providers to drive towards consensus.
Dr. Ted Mazer, former president of CMA and an independent practitioner in San Diego, CA, shares his experience with the statewide provider directory utility.
HIGHLIGHTS FROM OUR 2018 SOFT LAUNCH
In 2018, IHA partnered with three of the largest health plans in California (Anthem Blue Cross, Health Net, and Blue Shield of California), two large provider organizations (Hill Physicians and GlobalCare), and ten independent practices across the state.
The goal of the soft launch was to test the technology platform and data exchange process, establish baseline data around accuracy and gather feedback to improve the functionality and user experience.
Baseline statistics from our soft launch highlight the current gaps in data quality and the potential power of data matching
Providers that should be listed in a health plan’s online directory, but are not.
Providers listed in a health plan’s directory that should not be.
Providers that have incorrect information under “accepting new patients” status.
Data match in fields with strong reference source, such as the NPPES database for NPI.
With Symphony, we have a unique opportunity to bring more transparency to data inconsistencies and work together to improve the of quality data for all.
REVIEW OUR JOURNEY:
the path to a statewide provider directory
JOIN THE MOVEMENT
Request an assessment to learn how the Symphony Provider Directory can fit into your workflow.