BetterDoctor - The Origin of Accurate Provider Data

Health Plan Best Practices to Comply with SB-137

2018-08-22T00:00:00+00:00

California’s SB-137, the most strict provider directory compliance law in the country, is in full effect. All health plans in California must be fully compliant with SB-137 as of July 31, 2018.

When we say the strictest provider compliance law in the country, we’re not kidding. Although other state and federal regulators, the Centers for Medicare & Medicaid Services (CMS) for example, are starting to incorporate rules around provider directory data, SB-137 requires health plans to reach out to all contracted providers on a quarterly basis to update over 100 data attributes including:

Provider Name
NPI
Specialty
Admitting privileges at facilities
Panel status

Health plans must also update their online provider directory data at least weekly when informed of any changes from providers.

Several questions are probably running through your mind, such as:

How do I ensure my internal and external processes are 100% SB-137 compliant? What steps can I take to achieve better data accuracy within my health plan organization? How can I achieve better data, better networks, and a better consumer experience? How do I select the right vendor(s) to help?

The answer to that last question, choosing the right vendor to help, is the most critical. The right vendor can help guide you through all the answers. That’s why we’ve gathered seven best practices for choosing the right vendor for you.

Ensure that the vendor collects data through primary source data attestations and helps you be audit ready
Make sure your vendor is doing quarterly outreach to 100% of your provider network
Build effective multimodal outreach methods that are user-friendly for providers
Verify that your vendor is SB-137 compliant and approved by the DMHC
Check that your provider rosters are not causing conflicting data errors
Choose a vendor that helps you understand how accuracy changes impact your network adequacy
The vendor helps you improve your provider directory consumer experience

Ensure that the vendor collects data through primary source data attestations and helps you be audit ready

There is no safe harbor without having data about all communications with providers accessible. As you create internal processes to manage your provider directory accuracy, tracking changes and when they’re made is crucial. This metadata can help you resolve conflicting updates, or help you deal with any potential audits by a regulatory agency like the Department of Managed Health Care (CA DMHC) or CMS.

When choosing your vendor, ask how they manage metadata, and how it can help you address conflicting changes and potential audits. Some vendors will prepare you for any potential audits that may come your way. At Quest Analytics, we provide full transparency to support our health plan clients, through any auditing procedures.

Make sure vendor is doing quarterly outreach to 100% of your provider network

SB-137 requires you to update information with providers at least quarterly. Additionally, if there are any provider changes, health plans must update their online provider directories accordingly on a weekly basis.

Build effective multimodal outreach methods that are user-friendly for providers

When you’re working with vendors, ask how they reach out to providers. What kind of relationship do they have with providers? How often do they reach out to them? In what form do they communicate with them. Is it via email, fax, phone, mail, or all of the above? Ideally, you want diverse and consistent outreach methods that will collect the most accurate data online.

Verify that your vendor is SB-137 compliant and approved by the DMHC

It’s important to verify that the vendor you’re working with is SB-137 compliant. You can contact your state regulator at the Department of Managed Health Care to learn which vendors are SB-137 compliant. There are multiple vendors out there that can help you comply with SB-137, including the Quest Analytics’ Accuracy Solution — BetterDoctor.

You’ll also want to understand the SB-137 requirements. Under this state provider directory law, health plans must:

utilize uniform data definitions (defined by CMS, California Dept. of Insurance (CDI), & DMHC),
update online provider directories at least quarterly,
update online provider directory data weekly when informed of a change, and
ensure that directories have all relevant attributes including provider name, NPI, admitting privileges, and accepting new patients.

And that’s just for SB-137. To help create efficiencies for you and your organization, you’ll want to work with a vendor that can help you maintain compliance with other state and federal regulations, such as network adequacy and provider directory requirements for Medicare Advantage.

Check that your provider rosters are not causing conflicting data errors

Managing provider data is very complex. When the Quest Analytics’ Accuracy Solution — BetterDoctor— performs outreach directly to providers’ offices, our goal is to make practitioners and their office staff the primary owners of their data. That’s because they know it best. We have lived too long in an age where stale data is the norm. The process of collecting provider data through a health plan or IPA and having to wait for those updates to be acknowledged, processed and visible is antiquated and ineffective. When choosing a vendor ask about their outreach process. You’ll want to hear that they collect primary source attestations.

When the CMS performs ‘secret shopper’ audits, they directly contact healthcare provider offices. CMS considers individuals answering phone calls from members as the source of truth for provider data. It is in your best interest to make sure provider group rosters are not causing conflicting data errors in your provider directories.

For example, Quest Analytics performs two-factor authentication to validate provider status changes (e.g., deceased, retired, not at location) received through a pre-populated online form. We share these updates with the medical group(s) for roster integration, and with a health plan(s) to maintain directory accuracy, along with other critical errors identified (e.g., missing appointment phone number, incomplete address). Medical groups may independently partner with Quest Analytics for a group roster accuracy assessment and maintenance to meet SB-137 compliance and to more easily submit this data to health plans and other regulatory entities.

Choose a vendor that helps you understand how accuracy changes impact your network adequacy

As you clean up your data, this may impact your network adequacy results. Ask your vendor if they can help you condense your workflows to improve how you process changes quickly and efficiently. Additionally, make sure the vendor you work with offers simple data integration and ensures that you can get changes live in your directory in a timely manner.

At Quest Analytics, we understand how data accuracy and network adequacy are inextricably linked. Our Accuracy Solution integrates directly with the Quest Cloud Solution™ allowing you to monitor and trend changes within your network. As you incorporate accuracy changes, our cloud solution helps you identify any emerging gaps in adequacy and the providers available to fill them.

The vendor helps you improve your provider directory consumer experience

With Quest Analytics, we work with our health plans to encourage ongoing provider participation and consumer selection by educating the consumer with the results of the attested data. This approach has a direct impact on the consumer experience as well as provides additional incentives for the providers to continue ongoing participation.

Would you like to learn more about how to become SB-137 compliant? Let’s talk. Email laura.pereyra@questanalytics.com, and she’ll connect you with the best person to answer your specific questions.

At Quest Analytics we want to help health plans achieve Better Data. Better Networks. Better Experience. Quest Analytics is the provider data management and network analytics services company the nation’s health plans trust to provide a better experience for plan members by ensuring their networks comply with access, adequacy, and accuracy standards.

Vision Quest 2019 Registration is OPEN

2018-08-07T00:00:00+00:00

We’re excited to announce that our annual user conference, Vision Quest, is now open for registration. This year we are talking Accuracy. Adequacy. And Attestations.

The industry is putting a focused-lens on the link between data accuracy and network adequacy. It’s all about having better data, building better networks, and creating a better membership experience.

As our valued customer, we invite you to join us, your peers and industry-leaders as we work through these challenges together. During the conference, you’ll have the unique opportunity to:

Participate in experiential sessions with industry leaders
Gain best practices from real-world case studies and testimonials
Receive tactical trainings on Quest Analytics products, including tips and tricks
Get a glimpse at future initiatives and industry trends
Network inside Disney’s Animal Kingdom® during our evening reception in Pandora ─ the World of Avatar

Conference Registration Fees

(including breakfast, lunch, afternoon snack and evening reception)

First Attendee: $1295 ($1395 after September 30, 2018)

Second Attendee from same company: $1195 ($1295 after September 30, 2018)

Hotel Rate at Disney’s Boardwalk Inn:

Special block room rate for Vision Quest attendees of $259 per night plus tax, no resort fee

Register here

If you’re a Quest Analytics or BetterDoctor customer, please reach out and request a registration access code today. We can’t wait to see you there!

Our first meetup as Quest Analytics: Hands on data science and data engineering

2018-07-09T00:00:00+00:00

Welcome to our first meetup as Quest Analytics on Wednesday, July 25th!

This time, we will host an exciting data and developer focused evening where we actually get to see real-life challenges the two companies work on every day.

We will have our own Quest Analytics team and doc.ai team to present you how we work with healthcare data, present you some major data challenge that you can help us solve.

Both teams are also recruiting, so be sure to check open positions for Quest Analytics San Francisco team here: https://jobs.lever.co/betterdoctor/ & for doc.ai https://doc.ai/about#careers. This practical workshop is a great opportunity for you to learn about the data and the data related opportunities each company presents.

Agenda

6.30pm:

Networking, food & drinks provided!

7pm:

Welcome remarks, a round of talks and getting hands-on with the data challenges our speakers present, followed by a Q&A.

8.30pm: Hang out & chat with the speakers

Your Host: Pauliina Alanen, Quest Analytics

Our speakers are

Diane Kostka, Head of Data Operations, Quest Analytics (BetterDoctor)

Diane Kostka is a technical leader with a passion for using data to help solve healthcare problems. She works as Head of Data Operations at BetterDoctor, where she oversees and executes data operations, ETL, and exports for our health plan clients.

Melinda Heard, Data Engineer, Quest Analytics (BetterDoctor)

Melinda Heard works as a data engineer at Quest Analytics in Diane’s team. Prior to joining BetterDoctor she was at Privia Health and Kaiser Permanente. At the meetup, she will tell you about some of the biggest challenges with provider data, and brainstorm with the audience best ways to solve them.

Kartik Thakore, Sr. Data Scientist, doc.ai

Kartik Thakore, Sr. Data Scientist at doc.ai, has worked in the medical data space since 2011. His work brings artificial intelligence and statistical solutions to the medical health care landscape. He led his own startup, AIMED Stat Inc, and then subsequently joined other startups, BetterDoctor and Human API, before joining Doc.ai in 2018. Kartik also shares his data science expertise by advising several other startups in the Bay Area, London and Toronto on machine learning, data engineering and architectural directions.

Quest Analytics Presents New Combined Network Adequacy and Accuracy Solution at AHIP Institute 2018

2018-07-02T00:00:00+00:00

Last week, Quest Analytics’ CEO Ari Tulla and President and Co-Founder John Weis presented a newly combined network adequacy and accuracy solution for health plans during a session at AHIP Institute 2018.

This conference brought together key healthcare industry players including health plans, health groups, policymakers, and providers in San Diego.

The combination of Quest Analytics’ network decision-support tools and BetterDoctor’s primary-source verified provider data management platform will enable health plans to provide their members with convenient access to an adequate network of doctors and hospitals and an up-to-date, accurate directory of network providers.

Quest Analytics is the first comprehensive platform, designed exclusively to solve the data accuracy challenges, that enables health plans to optimize their member experience while complying with federal and state regulations for network adequacy and accuracy. Additionally, health plans receive comprehensive support for any potential provider data audits.

Why are accurate and adequate networks important?

The cost of healthcare continues to climb, prompting health plans to narrow their networks. These resulting networks provide limited access to providers and cause surprise billing for consumers.

Weis shared with session attendees his own personal experience with surprise billing

when his daughter faced an unexpected medical issue: “My own family faced this issue, and I know what I’m coming up against because I work in the industry. In an emergency, consumers need access to timely care without the fear of surprise billing. Our solution will help health plans create networks that are accurate and adequate for all consumers.”

Helping consumers find the care they need is what matters. Quest Analytics’ recent acquisition of BetterDoctor will help solve this problem more comprehensively with better data, better networks, and better consumer experience.

Interested in learning more about the Quest Cloud Services™, the Quest Analytics Suite™, or attested BetterDoctor data? Contact laura.pereyra@questanalytics.com.

For more information about Quest Analytics’ acquisition of BetterDoctor, please read the press release here: https://www.questanalytics.com/inthenews?id=3

Quest Analytics Acquires BetterDoctor

2018-06-18T06:07:53+00:00

Together the companies will create the first integrated platform for health plans to ensure network adequacy, data accuracy and enhanced member experience.

San Francisco, CA (June 18, 2018) – BetterDoctor, the nation’s most accurate provider data management platform, is proud to announce that we’re now a part of the Quest Analytics Team, the leading provider of network access and adequacy services to health plans and insurance regulatory agencies.

We are super excited for this new transition! Read the press release to learn more.

NPPES / NPI data with GraphQL - NPIQL.com

2018-06-05T06:07:53+00:00

This post is part of a more technical series about working with provider data and how to query provider data in the most effective way. Provider data is very complex due to its many relationships that depend on different values.

More often than not, a person looking for provider data does not necessarily want the entire data dump for a certain doctor, as this can mean hundreds of lines in JSON. Instead, one usually looks to just query a particular value to verify something. For example, one would query the addresses associated with a particular NPI. Long story short, the answer to having too much data to work with might be GraphQL.

In this first post of our technical series, we want to introduce data.npiql.com, which lets you query the API for the NPPES directory, otherwise known as the NPI directory. As NPPES puts it on their website, the “NPI Registry Public Search is a free directory of all active National Provider Identifier (NPI) records. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry”.

Data.npiql.com is a simple GraphQL interface used to query the NPPES / NPI Database. We created this simple tool for ourselves and thought it would be helpful to share.

If you’re not familiar with GraphQL, check out the example below.

First Things First… What is GraphQL?

GraphQL was created by Facebook. In a nutshell, GraphQL is a great way for your apps to request data in the API, which is an application programming interface that developers use to access data. There are many ways to query APIs to pull data, but one reason GraphQL is so cool, is that with GraphQL you can ask for exactly what you need, and get exactly that. Nothing more, and nothing less.

Here’s a Simple Example

Let’s say you have an NPI number like this one: 1316276066

What you want to do is to get the First Name, Last Name, Credentials and Address for that provider from the NPI Database. Although there’s a lot more information available, let’s assume that this is all you really want to see and nothing more.

Step 1) Go to data.npiql.com.

Step 2) Copy and paste the code into the left panel on the screen.

Step 3) Click the “Play” button at the top of the page.

Step 4) Marvel at the awesomeness! Or, figure out what you did wrong.

# This is the code you want to copy
{
  npiSearch(number:1316276066){
    results{            
      basic{
        first_name
        last_name
        credential        
      }
      addresses{
        address_purpose
        address_1
        address_2
        city
        state
        postal_code
      }
    }
  }
}

If you did everything right then the result will look like this.

# This is the result you want to marvel at
{
  "data": {
    "npiSearch": {
      "results": [
        {
          "basic": {
            "first_name": "JARED",
            "last_name": "POOL",
            "credential": "D.D.S."
          },
          "addresses": [
            {
              "address_purpose": "LOCATION",
              "address_1": "1719 POWELL ST",
              "address_2": "",
              "city": "SAN FRANCISCO",
              "state": "CA",
              "postal_code": "941332808"
            },
            {
              "address_purpose": "MAILING",
              "address_1": "1719 POWELL ST",
              "address_2": "",
              "city": "SAN FRANCISCO",
              "state": "CA",
              "postal_code": "941332808"
            }
          ]
        }
      ]
    }
  }
}

Give it a try

Play around with this to see how you can add and remove different data attributes.

Use the Docs

Note that there is a button on the top right of the screen labeled “Docs”. If you click that, you’ll be able to see all of the available data attributes, descriptions and how to include them. Spoiler alert… it’s all of the available NPESS Data Attributes.

Learn More

GraphQL can do a whole lot more. If this short intro is making your developer senses all tingly then I have some good news. The internet is just chocked full of free tutorials and it’s super easy to get started. The offical GraphQL website is a great place to begin.

Access BetterDoctor provider data

If GraphQL is not for you for now, you can query our provider database with our easy live documentation, or any language that you prefer. Just sign up for our provider data API for free on our developer site and try it out yourself. If you would like to use our provider data for your product or service, we should talk.

BetterDoctor and Quest Analytics at AHIP

2018-06-05T06:07:53+00:00

Come see us at AHIP Institute & Expo 2018 in San Diego!

AHIP Institute & Expo is a conference of creative thinking and sharing ideas with health care professionals from around the country. This year, BetterDoctor will share what it has learned from its work with health plans, health systems and health benefit exchanges about improving provider data accuracy and how to manage the data. Plus, we’re hosting a party, where you are most welcome to join! See all the details below.

Join us at our session below on Friday, June 22nd at 9:50am

Provider Networks and the Intrinsic Link Between Adequacy and Accuracy

Inaccurate provider directories can impede a consumer’s access to care. In this session, learn how and why two companies have partnered to create a solution that improves provider data accuracy. This can be achieved by combining provider data review processes with ongoing monitoring. During this session, you’ll gain best practices from industry experts on deploying a defendable, fully transparent process of ongoing compliance of provider data along with network adequacy compliance monitoring.

Ari Tulla, CEO & Co-Founder, BetterDoctor

John Weis, CEO, Quest Analytics

On Wednesday June 20th, the first day of the conference, we are also hosting a party alongside Quest Analytics and Zipari. We want to see you there, RSVP today!

HLTH 2018: BetterDoctor at The Future of Healthcare in May

2018-04-27T00:00:00+00:00

HLTH 2018 is a conference that brings together payers, providers, employers, government and disruptive startups to learn, collaborate, and evolve. We’re going there and hope you are too! If you don’t have a ticket yet, with promo code “betterdoctor150” you can get $150 off of the registration!

Want to talk provider data? So do we!

BetterDoctor will be there and we want to meet you! Get in touch to schedule a meeting, come and join the panel and our afterparty on Tuesday. Check full description for both below.

Ari Tulla, CEO of BetterDoctor will be on a panel speaking about how fixing provider data will open the floodgates to innovation in the healthcare ecosystem.

Session:

From Operating to Orchestrating (Track 3)

Tuesday May 8, 2018

9:20 am-10:00 am

How can the health industry use innovative technologies to make the cottage (legacy) industry perform more uniformly? Hear from those who are creating real-time, unified views of patients through data translation, data access (through APIs), and through integrated workflows across platforms, while meeting the compliance and regulatory conditions of health enterprises.

Speakers:

Ari Tulla, CEO & Co-Founder, BetterDoctor

Travis Good, MD CEO and Co-founder, Datica

Dr. William L. Kerr, CEO Avalon Healthcare Solutions

Alexi Gharib Nazem, MD, MBA, Co-founder & CEO, Nomad Health

Come visit us at our afterparty on Tuesday evening!

BetterDoctor and Newtopia have teamed up to host a happy hour at the HLTH 2018 Conference. Venue will be at a Penthouse location at The Aria. RSVP and you’ll get the details!

What would provider data management look on blockchain?

2018-04-27T00:00:00+00:00

Join us to take a deep dive into blockchain on May 1-2, 2018 at Washington Plaza Hotel, Washington D.C.

Our CTO Tapio Tolvanen is going to speak at Healthcare on the Blockchain conference, in Washington D.C. next week.

The panel discussion, entitled “Managing Data on the Blockchain for Cost-Savings and Error Reduction”, will be held on May 2 at 10.45 am.

The conference will cover topics relating to scalability, interoperability, performance, and security. Our panel will explore ways in which particular use cases in healthcare could be implemented on blockchain and how it can solve the future needs ahead due to the consumerization of healthcare.

We look forward to discussing how to innovate the technological capabilities in the industry in order to save costs, reduce errors, and also provide a better patient experience. The healthcare industry is ripe for innovation, so solutions to solve issues in interoperability, security and more are ahead.

For more information about how blockchain works, visit our previous blockchain post.

We look forward to seeing you at the panel!

Speakers:

Tapio Tolvanen, Co-Founder and Chief Technology Officer, BetterDoctor

Michael B. Marchant, HIE and Integration Manager, UC Davis Health

Srini Attili, Principal, Life Sciences and Healthcare, Deloitte

Webinar Recap: Provider Directory Data Management & Audit Tips and Tricks

2018-04-26T00:00:00+00:00

This month our webinar featured Gorman Health Group, Oliver Wyman, and Get Governed. These organizations work with many health plans to tackle provider data challenges. Our presenters shared their unique perspectives on how health plans have managed data.

We heard from:

Ellie Martin, Senior Director of Provider Innovations at Gorman Health Group
Frank Roberts, Engagement Manager at Oliver Wyman
Morgan Templar, CEO at Get Governed
Andrew Kobylinski, Head of Platform at BetterDoctor

We learned that health plans, health systems, and groups will have to make provider directory data accuracy a part of their ongoing operations. On the regulatory side, we delved deeper into what questions audits are focusing on to make sure that organizations plan their internal processes accordingly. And lastly, we discussed how providers would benefit from accurate provider data on several levels including how to refer patients to the right providers.

Watch a video recording of webinar here.

Successful Provider Data Management Requires Ongoing Operations Process

Leaving provider data management to periodic monitoring is no longer an option. The health plans who successfully manage their provider data make it a part of their ongoing operations. Ellie Martin talked about how health plans must think about how data is held, how it is accounted for in different requirements for different filings and lines of business.

She argues that managing provider data is now a part of life and it has been difficult for many health plans to adopt in a way that effectively yields tangible results. Audits have been tough to deal with, and now it’s important to have processes and resources as part of operations that generate results.

As Ellie puts it, “If your GPS were correct only 13 percent of the time, you would not be very happy.” She says that provider data quality has not been taken to heart completely. Now that CMS audits are underway, there is mounting pressure to make sure that we are doing everything we can as an industry to be correct.

Inaccuracies in data impact everything. Health plan sales reps might incorrectly represent networks to employers based on inaccurate data, for example. And with the consumerization of healthcare in full force, shoppers urgently need the right (online) information to choose the proper care. Health plans must continually monitor, audit, and update data. She recommends a monthly network adequacy report for management that will keep everyone in an organization on the same page about where data accuracy stands.

Above illustration from Ellie Martin, Gorman Health Group.

What Questions do You Need Answering to Be Audit Ready?

Morgan Templar, from Get Governed, has worked with regulators and health plans for many years. She shares the fundamental questions regulators need to be answered when they are performing audits: “What doctor can I see with my insurance coverage?”, “How do I contact a doctor to make an appointment?”, “If they send me to the hospital, will the charges be covered?”. These three questions are the crux of what matters for regulators looking at data quality.

Morgan walks us through the attributes that CMS audits have focused on to support a patient’s access to care. These attributes are: provider name, address of practice location, phone number, quality scores, cost transparency, and affiliated hospitals.

She shares how health plans waited to receive information from doctors in a more passive way. Now health plans must adopt proactive validation strategies and perform outreach to providers to keep data accurate at all times.

Understandably, this is not an easy task. One barrier to accurate data is that providers are not held accountable for updating their data. It is the health plans and payers that get penalized for having inaccurate data. One of the areas the industry could improve is making provider data accuracy a shared responsibility. The industry must figure out a way to enhance the experience for providers and have a better flow of information between provider and health plan/health group.

How Can Accurate Provider Data Help Providers?

Fixing inaccurate data will benefit providers and allow them to do their job more efficiently. Frank Roberts, Engagement Manager at Oliver Wyman, explained how providers need accurate data to refer patients to specialists. If providers don’t have the correct data about other providers who they need to refer patients to, care gets compromised. What’s more, inaccurate data interferes with the analytics providers need to practice effectively.

He explains, “without accurate data, the analytics that providers need to improve their practice will not work.” Oliver Wyman wants to be able to identify like-physician cohorts to provide physicians with accurate and actionable reports to help their patients.

Our presenters made it clear that regulators, health plans, and providers want, demand, and need accurate data. We share a common problem, and we all have a role in the solution.

Thanks to everyone that joined and participated in the webinar, see you next time!

To receive an invite to the next webinar, please submit a request here.

Watch video recording here.