Standardizes provider directory data sharing processes between Health Plans and providers.Reimagines provider directory interfaces leveraging Artificial Intelligence (AI) to assist members in finding the “optimal” provider for their needs.What does the industry need? A platform / product that: The Health Plan community has an opportunity to solve the provider directory challenge, however with CMS’s push towards interoperability and increased data sharing, a new door opens for a third party to gain patient’s favor. Pushing the healthcare industry to make provider data more readily available to third parties.Setting the foundation for the digital revolution of healthcare data by mandating use of FHIR/HL7 standards for the exchange of clinical, financial and administrative information between patients, Health Plans and providers.

Recent rulings from CMS and ONC on interoperability are again changing the game. The Federal Government is: Why is Healthcare different? The relationships complex and ever changing to a rate of 20% - 30% per year. Providers often cover for other providers, they retire or work part time for multiple practices, admitting privileges change, education or subspecialties change, and the list goes on. These relationship changes not only need to be reported by providers to all of the health plans they participate with (typically 10-12) by way of phone, fax, and email but each of those health plans need to then ingest that data and correctly and make updates across all of their systems. annual physicals, elective surgeries), they changed their hours of operation, some added additional services like COVID-19 testing or telehealth offerings. While previous health plan investments focused on data accuracy, limited investments were focused on flexibility with changing data elements, new service highlights, and new capabilities enabling health plans, and by association the Providers, to be more agile providing information to patients enabling them to quickly find what they need in a rapidly changing environment.Ĭonsumers have liquid expectations, expecting experiences to translate from one industry to the next. Often times provider directories require extensive clicks and information to generate a generic list of providers and have not kept pace with technology seen in other more consumer-centric industries. During the height of the pandemic, many providers discontinued their ordinary services (e.g. The COVID-19 health crisis has exacerbated the industry’s provider data management challenges but in a different way. Under the CMS rulings, health plans have invested heavily in provider directories over the past few years. Then, a global pandemic hits and the game changed again. Inaccurate or incomplete provider directories have always been a challenge for members there hasn't been burning platform for Health Plans to invest in addressing such a complex ecosystem of information. Inaccurate directories create burdens for everyone involved: Patients receive “surprise bills” because they visited a physician who they believed was in-network but was in fact erroneously listed in the provider directory and busy providers are often called to verify their practice information to keep directories timely. In 2016, CMS published rulings requiring Health plans administering Medicare Advantage to maintain accurate provider directories for members….and the game was changed.

Mike theis soleol