In our last article, we explored mental health ‘ghost’ networks as discussed in the May 3rd Senate Finance Committee hearing. We summarized the multiple causes of the problem and potential solutions. In this piece, we will explore how existing interoperability requirements for payer directories can be leveraged to support new solutions. The specific requirements we’ll …
Using Payer APIs to Improve Mental Health Networks Read More »
This is the first of a two-part series on mental health ghost networks. In the first post, we will assess the information presented on May 3rd at the Senate Finance Committee hearing. In the second part, we will explore how CMS-mandated Provider Directory APIs can be used to support the proposed solutions. Last week, the …
Knowing the number of payers that providers contract with is important for a few reasons. Reason 1: It is a proxy for administrative burden. The number of contracts can be a useful proxy for the administrative burden that multiplies as a provider contracts with more payers. This includes such tasks such as enrollment, credentialing, contracting, …
In our previous post, we reviewed the status of payer provider directory APIs and learned that some payers take a compliance-only mindset towards interoperability. Poor developer experiences are characterized by limited or non-existent documentation, broken APIs, and no communication channel to report issues. What does good look like? If we look among the payers, UnitedHealthcare, …
What a good developer experience looks like: VA Lighthouse Read More »
State of Payer Compliance on Provider Directory APIs It has been 18 months since the July 2021 effective date of the CMS Final Rule on Patient Access and Interoperability. In January 2022, we had identified Provider Directory APIs from 128 payers. Since then, we observed 78 additional payers publishing Provider Directory APIs. The addition of …
Provider Directory APIs: Beyond a Compliance-Only Mindset Read More »
In response to CMS’s RFI on a National Healthcare Directory (responses were due Thurs 12/6/2022), over 600 responses were submitted (around 50% of these were part of two major cut/paste campaigns, making the responses difficult to navigate on Regulations.gov). We reviewed and summarized the responses by industry segment. We also excerpted statements and linked to …
Responses to the CMS RFI on National Healthcare Directory Read More »
Executive Summary: CMS describes a National Healthcare Directory that will streamline provider data collection and promote interoperability. Years of industry engagement have produced layers of additional use cases. CMS should consider focusing on foundational data and not prematurely adding scope until it has established a complete, accurate provider demographic data set. CMS should also consider …
A Review of the CMS RFI on National Healthcare Directory Read More »
The Need for Linguistically-Appropriate Services On April 20, 2022, CMS released an action plan that establishes health equity as a ‘first pillar’ of its strategic vision under the Biden-Harris Administration. Included in its priorities are two actions that consider languages spoken: Promote culturally and linguistically appropriate services to ensure understandable and respectful care and services …
Defacto Health has been reviewing health insurers’ Provider Directory APIs in terms of availability, issues, and use cases for almost a year now. This post is a continuation, and we are focusing on the importance of health plan information within the APIs. While many exchanges between patients and providers about insurance stop short at “Do …
The Importance of Health Plan Information and Identity Read More »
When CMS issued its requirement for payers to publish Provider Directory APIs, it contemplated use cases such as in-network provider search and health plan shopping. Consumers shopping for health plans want to check whether their preferred providers are in-network, but they are also likely interested in the robustness of the network. Carriers may lever up …
Using Provider Directory APIs to assess provider network size Read More »
