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Provider Directories: An Opportunity Fraught with Challenges

by Naveen Rao | September 27, 2015

The Need for Reform

A primary goal of insurance expansion under the Affordable Care Act was to improve access to healthcare. Yet as thousands of people are finding, simply having insurance coverage does not guarantee that ‘the doctor will see them now.’

Due to poorly managed provider directories, a significant percentage of clinicians who are listed on a health plan’s website may not be operating at a given facility, accepting new patients, accepting certain insurance plans, or even actively practicing.

The Center for Medicare and Medicaid Services (CMS) has taken matters into their own hands with a series of regulations and reforms aimed to improve consumers’ experiences and protect them from out-of-network charges. These looming requirements around the creation and upkeep of accurate, up-to-date provider directories offer an opportunity for technology companies – though not without a fair set of challenges for vendors as well as health plans themselves.

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