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. As part of the California Department of Managed Health Care’s (DMHC) approval of Blue Shield’s 2015 acquisition of Care1st Health Plan, Blue Shield committed to investing in programs to strengthen the health care 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 health care system into one that is worthy of our family and friends and sustainably affordable,” said Paul Markovich, President and CEO, Blue Shield of California. “This includes working to bring health care into the digital age. 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.”
Recognizing stakeholder engagement would be critical to the success of such an effort, the DMHC and Blue Shield collaborated to guide a multi-stakeholder process in support of the creation of this utility. The California Provider Directory Collaborative launched in August 2016, establishing key workgroups. In November 2016, Blue Shield convened an advisory committee with membership representing health plans, providers, consumer groups and regulators.
The advisory committee defined the priorities, functions and governance requirements of the tool, and evaluated organizations as potential hosts for this utility. Ultimately, the advisory committee recommended selecting the nonprofit health care improvement collaborative Integrated Healthcare Association to develop and host this vital resource.
Markovich added, “We are excited to collaborate with Integrated Healthcare Association to advance this effort. IHA’s extensive experience and track record of launching and sustaining successful programs, commitment to a culture of collaboration, and ability to work closely with plans, providers, and other stakeholders, uniquely positions them for success in this much-needed endeavor.”
“IHA is thrilled to collaborate with Blue Shield of California in addressing one of the more vexing problems facing the health care industry,” said Jeff Rideout, M.D., IHA President and CEO. “IHA’s unique relationships with key stakeholders, data stewardship and passion for creating industry efficiencies positioned us well to develop a utility that will ensure end-users have access to accurate, reliable, complete and affordable provider directory data.”
The first of its kind in the state, this utility will offer a single place for providers and health plans to update their data, simplifying the process and leading to more accurate provider data, improved quality and a better customer experience for all Californians.
“Accurate provider directories are a basic element to consumers making informed health care decisions – from choosing the right health plan to accessing care once enrolled,” said DMHC Director Shelley Rouillard. “It is imperative the entire industry be actively involved in a solution that improves accuracy and reduces the burden on consumers to find providers in their health plan network. The Statewide Provider Directory Utility is a first step in getting to that solution, and I want to thank both Blue Shield and IHA for their commitment to move this project forward.”
Contact: Matthew Yi, 415-229-5359, firstname.lastname@example.org
Background on Blue Shield of California
Blue Shield of California, an independent member of the Blue Cross Blue Shield Association, is a not-for-profit health plan with 4 million members, 6,800 employees and more than $17 billion in annual revenue. Founded in 1939 and headquartered in San Francisco, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare health care service plans in California. The company’s mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield has contributed more than $450 million over the past since 2002 to the Blue Shield of California Foundation. Contact your local agent or broker about Blue Shield of California products and services, or visit www.blueshieldca.com.
Background on Integrated Healthcare Association
The nonprofit, nonpartisan Integrated Healthcare Association (IHA) convenes diverse stakeholders committed to advancing high-quality, affordable, patient-centered care across California and the nation. Founded in 1994 and based in Oakland, California, IHA is guided by a 40-member board of industry-leading health plans, physician organizations, and hospitals and health systems, plus representatives of consumer, purchaser, pharmaceutical, technology, academic and government entities. Together, IHA members represent the most diverse and influential cross section of health care organizations across California. IHA supports the continuing evolution of integrated patient care through financial and other means that align incentives for purchasers, payers, providers, and patients to achieve positive outcomes for patients and the public.