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Posted by on Dec 31, 2015 in Uncategorized | 0 comments

5 Recommendations for Building a Successful Integrated Exchange Directory

5 Recommendations for Building a Successful Integrated Exchange Directory

An Analysis of the Top Integrated Exchange Provider Directories

2016 Insurance Exchange

The Good, the Bad, and the Ugly – Policy Recommendations to Improve Consumer Choices

Clear Choices, a healthcare transparency advocacy effort of the Council for Affordable Health Coverage, released a scorecard for 12 state-based exchanges and HealthCare.gov in their recent publication, 2016 Health Insurance Exchanges; The Good, the Bad, and the Ugly – Policy Recommendations to Improve Consumer Choices.

One key portion of this scorecard looked at the inclusion of integrated provider directories in exchange platforms. Insurance exchange websites received a letter grade based on the inclusion of a directory and several additional directory features. Four insurance exchanges; Colorado, DC, Kentucky, and Washington, received an “A” for their provider directories, while Healthcare.gov received a “B.”

Looking at an “A” directory

In coordination with Consumers’ CHECKBOOK,  which works with exchanges to provide tools that support consumers’ decision-making, Strenuus powers the provider directory on DC Health Link, which received an “A” from Clear Choices for the website’s integrated provider directory. Our work supporting this project and other multi-carrier exchange directories, along with our long history in provider data, puts us in a unique position to go beyond looking at just the inclusion of a provider directory and comment on the functionality and usefulness of the information that is being served to shoppers.

Five Recommendations for a Successful Exchange Directory

Based on this experience, we developed a set of recommended best practices that should be included in the process of developing a meaningful, consumer-friendly, integrated online directory. We then used these five recommendations to assess the inclusion of these features in the four insurance exchange website directories that received an “A” and HealthCare.gov that received a “B”.

Recommendations for Building a Successful Integrated Exchange Directory

  1. Remove duplicate records to ensure consistency in identifying unique providers
  2. Include disclaimers that ensure consumers understand the limitations of the online directory
  3. Include doctor profiles with additional provider details
  4. Include a feature that allows for the reporting of errors in provider information
  5. Develop a method for ranking multiple-provider inclusion in networks

1)   Remove duplicate records to ensure consistency in identifying unique providers

The process of identifying unique providers across multiple payor provider data sources can be extremely complex, but it is necessary to deliver meaningful information. Payors all have their own methods for storing provider information; there are variations in provider names, specialties, and addresses. When a provider has multiple records in an online directory, the surfaced information can be misleading and cause greater confusion as shoppers try to determine which provider record is accurate.

1. Remove duplicate records

2)   Include disclaimers that ensure consumers understand the limitations of the online directory and their responsibility for verifying participating providers

Even with the most reliable data, there is still room for error – provider information is constantly changing. This means it is extremely important for the shopper to understand the limitations of the online directory and their responsibility for verifying that their provider is in-network with a specific plan.

2. Include disclaimers that ensure

3)   Include doctor profiles with additional provider details

Providing additional provider details helps ensure shoppers are choosing the correct providers. Some of the exchange directories don’t even have information about provider specialties.

3. Include doctor profiles

4)   Include a feature that allows for the reporting of errors in provider information

Given that provider information is constantly changing; it is key that consumers and providers have a process for reporting errors in the data.

4. Include a feature

5)  Develop a method for ranking multiple-provider inclusion in networks

The ability for shoppers to view multiple providers and their network participation in one view greatly simplifies the shopping experience and allows consumers to choose their best-fit network. Looking up providers one at a time to view plan affiliations complicates the shopping experience. With the increased use of narrow networks on the exchanges; it is becoming unlikely that a consumer with multiple preferredproviders will be able to find a plan that includes all of them.

5. A method for ranking multiple

Assessing Integrated Provider Directories

We used the five recommendations for building a successful integrated exchange directory to assess the inclusion of these features in the four insurance exchange website directories that received an “A” and HealthCare.gov.

Multi-Payor Integrated Provider Directory Recommendations

If you are a health plan and would like to know more about how Strenuus can help, please click here.

If you are an exchange and would like to know more about how Strenuus can help, please contact us at sales@strenuus.com or 866-796-7507.

 

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