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Improving Provider Directory Accuracy: Can Machine-Readable Directories Help?
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Improving Provider Directory Accuracy: Can Machine-Readable Directories Help?

Michael Adelberg, MA, MPP; Austin Frakt, PhD; Daniel Polsky, PhD; and Michelle Kitchman Strollo, DrPH, MHS
The authors examined the accuracy of provider directories and found widespread errors. Machine-readable directories are not more accurate than conventional directories, despite their advantages. A survey of promising initiatives to improve directory accuracy was also completed.
DISCUSSION

The information contained in provider directories is inaccurate across information types and markets (ie, the inaccuracy rate of provider addresses ranges from 27% to 35%, and the inaccuracy rate of provider phone numbers ranges from 25% to 48%). Although the facts are straightforward, the reasons behind them are complex: As noted by interviewees, providers often treat maintaining current directory information as a low priority; there is a lack of consistent standards or a common data dictionary for provider information; there is no central, reliable information source (“source of truth”) against which to assert accuracy; and there is no harmonized federal strategy to address the problem. As argued by CMS in its 2020 Call Letter, health plans cannot solve this inaccuracy problem on their own.10

As noted, promising initiatives are now underway in a few states, and a few vendors are now offering promising accuracy tools (see eAppendix A), but we will not know their results for years. In the interim, MR directories offer great advantages over conventional directories, including crowdsourcing to identify information that is likely erroneous and quick data aggregation for ongoing network analyses. MR directories are mandated in the health insurance exchanges and Medicaid, but not federally enforced. They are recommended as a best practice in MA, but there is no evidence that they are widely used by MA health plans.11 The loose regulation of MA directories contrasts with CMS’ affirmative regulation of this market in most other respects. CMS Deputy Administrator Demetrios Kouzoukas warned MA organizations about the need for directory accuracy at the May 10, 2018, CMS Medicare Advantage and Part D conference, but without recommending the use of MR directories.12 The lack of a harmonized position on MR provider directories across markets merits further consideration. CMS’ recent requirement for hospitals to post MR hospital pricing information “to further improve the public accessibility of charge information” demonstrates that it values the technology.13

Our analysis focused on whether MR directories can result in more accurate information on network providers. It did not focus on whether MR directories can be used to lessen the instances in which in-network providers are omitted or out-of-network providers are included. More research is needed on these topics.

Recommendations

Fully utilize MR directory advantages. For CMS and other entities requiring MR directories, it is incumbent to utilize the advantages of machine readability. CMS required exchange plans to invest in machine readability and endure a bumpy rollout, but it has not yet leveraged all of the considerable benefits of machine readability. The advantage of the technology can be utilized in a nonpunitive manner by having CMS and health plans partner to improve directory accuracy.

Watch for emerging best practices. Regulators and researchers should analyze state and vendor initiatives to improve provider data accuracy. California’s statewide provider network utility and New Hampshire’s use of claims data to determine actual provider network are particularly interesting initiatives. These and other potential long-term accuracy solutions are summarized in eAppendix A. They may subsume and surpass the advantages provided by MR directories.

Clarify federal role. Federal policy makers should consider benefits of federal leadership in correcting provider directory inaccuracy. Our analysis suggests that Medicare’s NPPES file is less accurate than health plan provider directories. This required Medicare data source could be reimagined to become a source of provider information accuracy. More broadly, national and transmarket efficiencies could be realized by establishing a national data dictionary and requirements across markets. In this regard, initiatives by HHS’ Office of the National Coordinator for Health Information Technology and CMS merit watching, including a recent proposal to require MA and Medicaid health plans to make provider directories available in a common electronic format equivalent to MR.14,15

CONCLUSIONS

MR directories offer significant advantages over conventional directories. As noted in eAppendix B, data can be downloaded at roughly $0.01 per provider from an MR directory compared with $2.15 per provider from a conventional directory. This efficiency makes provider network aggregation and comparisons feasible for the first time. This, in turn, powers the potential of MR directories to improve the transparency and accuracy of provider information. However, machine readability does not correct inaccuracies by itself. We found that MR exchange plan directories are slightly less accurate than conventional MA directories. This is likely because MA plans (facing oversight from CMS) are working to raise the accuracy of MA directories, whereas there is no equivalent pressure to improve directory accuracy in the exchanges.

Acknowledgments

The authors thank Timothy Riddle, MSMIS, MBA, of NORC; Kacey Stotler, MSW, of Faegre Baker Daniels Consulting; and Tricia Beckmann, JD, of Faegre Baker Daniels Consulting, for their work on this project.

Author Affiliations: Faegre Baker Daniels Consulting (MA), Washington, DC; Department of Veterans Affairs (AF), West Roxbury, MA; Boston University (AF), Boston, MA; Harvard University (AF), Cambridge, MA; Leonard Davis Institute of Health Economics, University of Pennsylvania (DP), Philadelphia, PA; NORC at the University of Chicago (MKS), Bethesda, MD.

Source of Funding: The Commonwealth Fund.

Author Disclosures: Mr Adelberg received grant funding from The Commonwealth Fund and has spoken on this topic at meetings/conferences. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MA, DP, MKS); acquisition of data (MA, MKS); analysis and interpretation of data (MA, AF, DP, MKS); drafting of the manuscript (MA, AF, MKS); critical revision of the manuscript for important intellectual content (MA, AF, DP, MKS); and obtaining funding (MA).

Address Correspondence to: Michael S. Adelberg, MA, MPP, Faegre Baker Daniels Consulting, 1050 K St, Washington, DC 20001. Email: Michael.Adelberg@faegrebd.com.
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