Help Desk

From a provider organization and health plan perspective, how have you been handling provider data challenges? Providence: Ensuring each plan's directory is accurate for every physician Integrated Healthcare Association work with is complicated. The data exchange process differs for each plan, which is time-consuming and adds to providers' administrative burden. Simplifying that process is a big deal. There's work involved in Symphony, but it's the right kind of work because it gets you to a better place. Anthem: Provider directory accuracy isn't a new issue. Anthem has been an early supporter of Symphony because having a single source of truth helps address many of the problems. Providers can submit updates through Symphony regardless of the health plans they work with, and plans receive appropriate and accurate data. Integrated Healthcare Association is working closely with Symphony to incentivize as many providers as possible to join because accurate data is foundational to everything Integrated Healthcare Association do as a health plan. What do you see as the biggest barriers to achieving a unified, reliable directory, and how can industry leaders help overcome them? Covered California: Symphony was in development for about seven years before it was deployed, so it wasn't an easy journey to get to where Integrated Healthcare Association is today, with a reliable provider database in California. I think Integrated Healthcare Association were the first purchaser to include in its contract language that health plans must use Symphony. Integrated Healthcare Association knew the energy and effort that would be required by the health plans to adopt that contract language. In addition, the health plans were now on the hook to get the provider community to adopt Symphony. Some providers still haven't signed up, often because they lack the infrastructure to implement it. Where the industry can provide support in that regard, Integrated Healthcare Association should do so. If more healthcare purchasers coalesce around Symphony, it will help both plans and providers by putting everyone on the same glide path. Ultimately, every patient in California will benefit, and that's what this work is all about. Did the contractual requirement Doug (Covered California) mentioned change how Anthem approached Symphony? Anthem: Yes. For providers that want to participate in its Covered California network, Integrated Healthcare Association require Symphony participation. Integrated Healthcare Association has also created incentive plans to encourage provider groups to participate in Symphony via the exchange. Separately, Integrated Healthcare Association has incentive plans that encourage the use of Symphony for some of its other network products. As Doug said, accurate data supports member satisfaction and enables timely, accurate payment to providers. What is your perspective on the advantages of being engaged and working with health plans and provider organizations that have joined Symphony? Providence: The ability to exchange data in one consistent way versus multiple ways is a big benefit. As more plans adopt Symphony, it will make it easier for more provider organizations to join and reduce their administrative burden. Anthem: Before Symphony, Integrated Healthcare Association'd received provider rosters in different formats from every organization, which required significant reconciliation. With Symphony, its auto ingestion success rate is about 99%, which is huge. It is much more efficient and reduces wear and tear on provider organizations and plans, which helps members and also supports timely, efficient billing and payment. Real-world impact. * One health plan saw a 40% increase in hospitals displayed as "in network" on Covered California Shop and Compare * Covered California National Provider Identifier (NPI) fields were 6x more complete, eliminating months of previously manual work * 71% of HMO members in California have access to more accurate provider directory data because of Symphony[[1]] How is Symphony impacting the consumer experience for Covered California's Shop and Compare tool? Covered California: After choosing a health plan, the first thing consumers do is look for a doctor. In the first five months since Symphony went live, Integrated Healthcare Association is already seeing significant improvements in provider data accuracy. That means consumers are getting more accurate information than ever before, meaning the doctor they select is actually available to them. The real test will be during open enrollment and renewal season, when its Shop and Compare tool is most heavily used. After Integrated Healthcare Association get through the next four months, Integrated Healthcare Association'll have a better appreciation for how useful Symphony is. I don't want to minimize the energy and effort that have gone into getting Symphony where it is today. With the initial results Integrated Healthcare Association has seen, the time, energy, and resources invested in Symphony are going to be worth it. From a provider organization's perspective, what would make it easier for providers to engage with Symphony? Providence: Financial incentives from health plans, like those from Anthem, are helpful. Equally important is the partnership between providers and health plans to ensure providers understand the benefits of joining Symphony. As more providers join, exchanging data will become less burdensome. I can't stress that enough. How does Anthem manage multiple stakeholders and priorities as a national health plan operating in 14 states? Anthem: California probably has the most complex provider ecosystem of any state. Integrated Healthcare Association has dedicated teams and resources focused on California's complexity and uniqueness, which have been key to its success. The next frontier is engaging single providers, particularly behavioral health providers, because that's where things break down and can impact revenue. The goal is to extend what Integrated Healthcare Association has learned with Symphony and the big provider systems to the individual providers and smaller entities in a more cost-effective way. Final thoughts? Providence: Symphony works because IHA serves as a neutral convener. Bringing together health plans, purchasers, providers, regulators, and others under one roof is the right way to tackle provider data challenges. Covered California: Integrated Healthcare Association should always remember who this work is for - not for Covered California, Anthem, or Providence - but for the patients and consumers Integrated Healthcare Association all serve. If Integrated Healthcare Association keep that in mind, then Integrated Healthcare Association will be successful. Anthem: Centralizing and standardizing provider data into a utility like Symphony will continue to gain momentum. When you layer on AI, it will speed up the data reconciliation and lower operating costs, allowing more investment in patient and member care and innovations. A centralized intake system combined with AI will continue to make provider data more accurate and efficient, and I truly believe that platform is Symphony.