CHA News Article

Report Examines Challenges and Solutions for Maintaining Provider Directories

The California HealthCare Foundation (CHCF) has released a report that examines the policy, operational, business and technical obstacles to well functioning, integrated provider directories. The report focuses on how those obstacles have been overcome in four states — Colorado, Maryland, New York and Washington. Detailing the perspectives and experiences of consumer advocates, carriers, providers, state-based marketplaces and state Medicaid agencies in those states, the report’s goal is to inform California policymakers and stakeholders as they seek to improve consumer access to accurate provider network information. It includes the following areas related to provider directories: policies, regulations, and enforcement; data standards; data integrity; time and resource requirements; consumer decision making; provider contracting; and considerations for California.

Key report findings include:

  • An environment for shared accountability can be fostered through incentives, policy alignment, and enforcement of regulatory and contractual requirements.
  • Creation of uniform data standards and accompanying guidance can help ensure that data are usable, especially when they come from disparate sources.
  • Efforts to audit, perform quality assurance and verify the accuracy of provider directory data vary widely, with many organizations performing little or no quality review.
  • Organizations typically rely on time- and labor-intensive manual processes to develop and support provider directories.
  • Provider directories should engage and inform consumers with diverse language needs and educational levels as they enroll in coverage and seek care.
  • Providers need clear information about contracting and participating in specific carrier products, as well as the requirements and processes of updating their data.

The full report is available on the CHCF website.

Commands