Healthcare is the most intermediated business in the history of the world. There’s always someone, and usually several someones, in between the clinician and the patient. Similarly, while most of us working on the business of healthcare will enthusiastically agree that we do this for the patients, we spend very little time talking about them. Of course, I’m not referring to the “front-lines” of healthcare delivery (i.e. doctors, nurses, etc.) or even their immediate support team at the hospitals and clinics. I’m talking about those of us who are working in the background to enable “healthcare transformation”.  While we try to fix provider directories, calculate quality measures and otherwise streamline the business of healthcare, we’re regularly focused on the complex, technical details of those problems. The concept of the patient is usually abstracted. Even when we talk about things like “covered lives”, we tend not to discuss them as actual people; as our grandparents or brothers or children.

That’s not wrong, per se. We all need to focus on our part of the mission and trust that our “team” is giving us the right problems to solve. However, we may be selling ourselves short. It can be incredibly powerful to remind ourselves from time to time that we are, in fact, ultimately working for the patients. It’s the “commander’s intent” behind what we’re doing and should guide us as we make 100s of seemingly unrelated micro-decisions throughout our day. The expanded perspective helps us to re-center our “why” and keeps us moving productively towards a healthcare system that works for all of us (i.e. patients, providers, health plans, administrators, entrepreneurs, government, etc.).

That’s why we talked to Tam Ma, Legal and Policy Director at Health Access California. Tam explains why provider directory accuracy is so important from the patient’s perspective and why her organization was vocal in the crafting of California’s SB-137 legislation. In doing so, she helped me realize that we’re aiming way too low with our solutions in this space. We’re still struggling with the basics:

  • Where does the doctor work?
  • How do I contact them?
  • Are they accepting new patients?
  • Will they accept my plan, or will I get nailed with dramatically higher out-of-network charges?
  • Etc.

We’ve demonstrated the reasons why these seemingly simple questions are so difficult to answer throughout this series. It’s hard, but we shouldn’t expect any pats on the back when we’re done. Instead, we should expect a resounding “It’s about time” from the patients. That’s because we’re still playing catch-up with their most basic expectations. I should know who’s in a plan before I buy it. They should be able to tell me the doctor’s correct phone number. By looking at this patient perspective, we can start to see why this isn’t enough. It’s a step on the path, but we need to aim higher so we can start to deliver real value and truly address the convenience and access issues that patients face. When a patient can reliably search for a dermatologist who participates in Medicaid, is accepting new patients, offers Saturday appointments and has an office (that they actually work at) on the 15 bus line, then we’ll have arrived.

Tam and I break down these ideas and much more including:

  • What is Health Access California?
  • Why did you get involved in SB-137?
  • Where do provider directories fall short?
  • Who’s responsible for provider directory accuracy? Who should be held accountable?
  •  SB-137 has provisions that allow health plans to take action against non-compliant providers (i.e. de-listing). Are these viable options in the face of network adequacy regulations and other tangential pressures?
  • Beyond having accurate information, how can we improve provider directories for the patients?
  • What customer-facing tools can we adopt from other industries like retail?

Bonus: Tam tells us about new regulations in California that protect patients against unexpected out-of-network bills.

I hope this episode broadens your horizons on what a proper provider directory should look like. It did for me.

Enjoy!

– Don Lee

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About Tam Ma

Tam M. Ma is Legal and Policy Director at Health Access California, where she represents the interests of health care consumers in the Legislature and before administrative and regulatory entities. Tam started her career as a California Senate Fellow and was previously senior staff to Senators Mark Leno and Sheila Kuehl, where she advised the Senators on policy and state budget issues relating to health and human services, consumer protection, housing, judiciary, and women’s issues. She also advocated for the rights of low-income tenants when she was a trial attorney with Legal Services of Northern California’s Sargent Shriver Civil Counsel Act project.

Tam was honored by the California Partnership to End Domestic Violence and the California Coalition Against Sexual Assault for her work to strengthen protections for survivors of these crimes. She sits on the board of the Women’s Foundation of California and has served as a trainer and mentor for the foundation’s award-winning Women’s Policy Institute since its inception in 2003. Tam also serves on the board of the Asian/Pacific Bar Association of Sacramento and is Past President of My Sister’s House, a domestic violence shelter serving women throughout the Central Valley. Tam received her B.A. and J.D. from the University of California, Berkeley.


About Health Access California

Health Access California is the statewide health care consumer advocacy coalition, advocating for quality, affordable health care for all Californians.

As a coalition organization representing consumer groups, communities of color, immigrants, people with disabilities, children, seniors, women, people of faith, and organized labor. Health Access seeks to connect grassroots organizing to policy work, on-the-ground mobilization with savvy Sacramento strategy. Coalition member organizations can count on Health Access for timely analysis and tools so that whatever time and effort they have for health advocacy is spent in the most effective way possible.

http://www.health-access.org/

@healthaccess


Mentioned on the Show

Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans (Health Affairs)

DMHC Fines Blue Shield and Anthem for Provider Directory Inaccuracies


About the Provider Directory Podcast Series

This episode is part of our ongoing Provider Directory series that aims to dissect the issue from all perspectives, including provider, payer, patient, and regulator. Our goal is to help facilitate an expanded national conversation that drives us towards an open, collaborative industry solution.

Check out all our Provider Directory posts and episodes here!


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