Patients are buying health insurance based on misleading information. Incomplete or incorrect provider directories can obstruct patients from accessing care. Additionally, the healthcare industry is building its administrative workflows on top of this bad provider data, creating all types of inefficiency. Today on the podcast I’m joined by Dara Price-Olsen and Tammy Weaver to discuss the LexisNexis and AMA Collaboration Provider Directories. We hear a story early on showing how easy it is to be fooled into purchasing a restrictive or needlessly expensive plan. We also get into the details on how claims data can give us new insights to help fix this problem.
Check-out our extensive coverage of the problem with and attempts to fix it: Provider Directory
2:02 Background of the provider directory issue: patient access and administrative burden.
4:50 Consumers are having coverage issues making it hard to shop for healthcare due to incorrect info.
6:44 The patient perspective. Inaccurate and misleading options could have real consequences.
10:36 When consumers need answers and neither doctors or health insurers can help, how do you handle this?
12:40 A 2016 audit found 45% of directory information was deficient enough to effect access to care. In 2017, 52% was deficient.
15:44 Why is the problem getting worse if there is so much focus and effort trying to fix it?
17:15 What are the issues that CMS found? 2.4% of providers need to update their information each month. That’s 28% a year. You can’t just assume all 28% are going to call and update you.
21:45 What is Roster Inflation? How does this relate to Data Fidelity?
25:50 CMS enforcement actions are coming! Be able to demonstrate how you’re working on this problem.
28:43 Health plans should be using all the data available to them to solve this problem. Look at claims data to validate or flag what providers are telling them.
30:00 The AMA – LexisNexis Collaboration
33:10 Instead of driving outreach that costs money and increases administrative burden, use that data you already have.
34:50 Insights derived by claims data.
39:04 Who is the customer and who will benefit from the collaboration?
42:42 VerifyHCP will streamline keeping your directory up-to-date.
47:47 Start with the low hanging fruit and become more and more automated over time.
49:10 The Frictionless System
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About Dara Price-Olsen
Dara Price-Olsen is the Senior Director of Product Management & Market Planning at LexisNexis. Dara is putting her 28 years of experience to use in developing a collaboration with the AMA to improve the dismal state of doctor directories. Dara received her BS in Computer Engineering from Iowa State University.
About Lexis Nexis
LexisNexis® Risk Solutions provides customers with solutions and decision tools that combine public and industry speciﬁc content with advanced technology and analytics to assist them in evaluating and predicting risk and enhancing operational efﬁciency.
We use the power of data and advanced analytics to help our customers make better, timelier decisions. Our innovative solutions enable organizations to manage risks like identity theft, fraud, money laundering and terrorism, and prevent ﬁnancial crimes, and insurance and government beneﬁt scams. We help those without traditional credit histories obtain access to funds, assist agencies to ﬁnd uncollected revenue, and research ways to improve business outcomes for healthcare companies. We also work with law enforcement to solve crimes.
By bringing clarity to information, we ultimately help make communities safer, insurance rates more accurate, commerce more transparent, business decisions easier and processes more efﬁcient.
LexisNexis® Risk Solutions and its sister company LexisNexis® Legal & Professional are part of RELX Group, a global provider of information and analytics for professional and business customers across industries. The group serves customers in more than 180 countries and has offices in about 40 countries. It employs approximately 30,000 people of whom half are in North America.
About Tammy Weaver
Tammy Weaver is the Director of Database Products Portfolio at the American Medical Association. Tammy is a results-oriented professional with robust product management, marketing and client relationship management experience. Tammy is adept at analyzing market trends, developing and executing business strategies. Demonstrated ability to generate new business, and manage and expand existing customer bases within competitive industries.
About American Medical Association
The American Medical Association is the powerful ally and unifying voice for America’s physicians, the patients they serve, and the promise of a healthier nation. The AMA attacks the dysfunction in health care by removing obstacles and burdens that interfere with patient care. It reimagines medical education, training, and lifelong learning for the digital age to help physicians grow at every stage of their careers, and it improves the health of the nation by confronting the increasing chronic disease burden. For more information, visit ama-assn.org.
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