Consumer / Employer, Payers

CMS is proposing a national provider directory. Here’s what AHIP thinks it should look like

CMS is proposing a system in which it would collect information from providers that would go in a single national directory it maintains. AHIP is seeking a more collaborative directory between the government and private insurers.

The Centers for Medicare and Medicaid Services (CMS) requested public input on creating a CMS-led national directory of providers and services last week. While America’s Health Insurance Plans (AHIP) agrees with having a national directory, the organization has a slightly different vision for it.

CMS is proposing a system in which it would collect information from providers that would go in a single directory that it maintains. The directory would then be shared with users. It would allow patients to find and compare providers based on certain preferences, such as language and location.

“CMS would be the host of [the directory] and the owner of that,” Danielle Lloyd, senior vice president of private market innovations and quality initiatives for AHIP, said in an interview. “They would be the organization that would be aggregating the information and verifying all the information and determining what information goes in there.”

AHIP, however, would like the directory to be more collaborative between private payers and the federal government so additional information that private insurers need could be added, Lloyd said. 

When you think about original Medicare, for example, it doesn’t really have a network since almost every physician accepts it,” Lloyd said. “For a private payer, each plan product may have a different network. So, it’s not enough to know whether a provider takes Plan A, you have to know whether it takes Plan A’s HMO product, or PPO product, or both. And, you need to know if that differs by location if they practice part of the week in one place and part of the week in another.

“Unfortunately, if a directories solution doesn’t also meet the needs of the private payers, there will still be a fragmented system,” she added.

Still, a national directory would be a major benefit to the American healthcare system, Lloyd said. Currently, each health plan has to get information from each provider, a process that’s burdensome and confusing.

“That means that providers are getting a lot of requests, and that can lead to unresponsiveness or sometimes errors because it’s such a difficult process,” Lloyd stated. “Then you layer on that the information is changing all the time, so it’s definitely a complex system that could use some streamlining.”

Ultimately these issues then trickle down to the patient, who is “sometimes struggling to find up-to-date information about providers in their network,” CMS said in a news release.

A huge expense comes with the fragmented system, too. A 2019 provider survey found that maintaining directories cost physician practices $2.76 billion annually. These practices could save $1.1 billion annually if there were a single platform for directories, the same report showed.

AHIP will be submitting its comments on the national directory to CMS during the comment period, which ends December 6. As to whether CMS will be open to AHIP’s ideas, Lloyd said she is hopeful.

“It remains to be seen,” she said. “We have to submit our comments and see how they respond. Certainly there are many other ways in which we work with the government in this public-private fashion, so we are hopeful this is something they would be interested in.”

Ultimately, a national directory is necessary to help patients receive the care they need, Lloyd declared.

“At the end of the day, this information is really critical for consumers in their coverage shopping and for maximizing their benefits, and we want to do all that we can to make sure they’re as up to date as possible,” she said.

Photo: designer491, Getty Images

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