A trade association and Blue Shield of California expect to build and pilot the provider directory next year and launch a full-scale version in 2019.

Details are sketchy but a big California health insurer is working with a big trade association to build an online directory that will give California consumers a better way to locate and research healthcare providers.

Yesterday Blue Shield of California, which has more than four million plan members, in conjunction with Integrated Healthcare Association, an Oakland healthcare trade group and research organization, announced the framework of a plan to build a statewide provider directory “utility” to ensure consumers throughout California have the most up-to-date and accurate information about providers when choosing a health plan.

The trade association and Blue Shield of California expect to build and pilot the provider directory next year and launch a full-scale version in 2019. But other key details such the cost of the project, the scope and source of the data to be housed in the utility and where it will be located online have yet to be determined.

But once built, the size and scope of the utility could serve as a blueprint for how other local, regional and national healthcare organizations build better provider directories, says Integrated Healthcare Association director of strategic initiatives Eyal Gurion.

Health plans have been challenged to provide accurate public provider directories.

Today web-based provider directories that consumers can use to find and review healthcare providers and make appointments are chock full of outdated and at times erroneous information that’s rarely updated on a regular basis.


For example in February the federal government putt 21 major health insurance companies that administer Medicare plans on notice that they have major problems with the accuracy of their online provider directories. A government report found almost half of the 5,832 doctors listed had incorrect information, including wrong addresses and wrong phone numbers. Most health plans had inaccurate information for between 30% and 60% of their providers’ offices.

“Consumers increasingly rely on provider directories to review networks when choosing a health plan, yet health plans have been challenged to provide accurate public provider directories that reflect the various types of providers available through their networks, their qualifications and capabilities and their availability,” Gurion says. “Longstanding challenges around the accuracy of provider data are magnified by confusion associated with complex and uncoordinated regulatory requirements, quickly changing data and outdated systems and processes.”

California has one of the country’s biggest healthcare systems. At present, California’s system includes 33.4 million people who have some form of health insurance coverage. Each year California, which has 346 hospitals and 143,427 licensed physicians, spends nearly $400 billion on healthcare, says the Political Policy Research Institute.

But statewide provider directories are not integrated and don’t give consumers full and comprehensive access to data to find, rate and review doctors. The new Blue Shield of California and Integrated Healthcare Association provider utility is meant to be comprehensive and up to date, with information that is updated at least quarterly.

The accuracy of provider information has been a longstanding challenge for the industry, and the issue was magnified when millions more Californians gained access to coverage following the implementation of the Affordable Care Act, says Blue Shield of California CEO Paul Markovich. As part of the California Department of Managed Health Care’s approval of Blue Shield’s $1.2 billion 2015 acquisition of Care1st Health Plan, Blue Shield committed to investing in programs to strengthen the healthcare delivery system in California, including “the development of a statewide centralized provider directory database.”


“Blue Shield of California is committed to transforming a fragmented and overly complex healthcare system,” Markovich says. “This includes working to bring healthcare into the digital age, and a statewide provider directory utility will benefit consumers who rely on the accuracy of provider directories when making decisions about their health coverage and will reduce the administrative burden on health plans and providers.”

The utility will be a back-end provider data database which will consolidate, cleanse and validate data for multiple plans and providers for better data quality and accuracy, California Blue Shield says.  “Consumers will still use each prospective health plan’s website to review the providers in each network, but this tool will also feed into multi-plan directories such as Covered California,” says a California Blue Shield spokesman.

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