The Symphony Provider Directory is a centralized, statewide cloud-based technology platform for providers and health plans that will serve as a single source for provider directory data such as demographics, services, products and networks.
Symphony will help maintain up-to-date, accurate, on-demand data about provider participation within health plan networks in California while lowering the administrative burden for plans and providers, making it easier to meet regulatory and business requirements, and ultimately helping consumers to find the right providers and select the right health plan.
Maintaining up-to-date information about provider participation in health plan networks has been a long-standing challenge. The Affordable Care Act magnified this issue as more consumers made health care coverage decisions based on inaccurate provider data.
The current system of data collection is fragmented, duplicative and wasteful, contributing to a staggering $361 billion in healthcare administration costs annually in the U.S. And the information is often still not accurate. Symphony will support both health plan and provider needs by delivering accurate information, validating, verifying, and reconciling data, lowering provider directory management costs, and supporting compliance with SB 137*, Medicare and Medi-Cal requirements.
*SB 137 refers to Senate Bill No. 137 and regulates health plans to take appropriate steps to ensure their provider directory information is up to date and accurate.
Symphony is a technology platform from which all health plans can pull verified and validated provider data to populate their online directories. Provider organizations will use Symphony to receive extracts of their data for verification or editing, and independent practices will make edits directly in the portal. Providers will not need to send data in different formats to each plan and they will not need to answer multiple requests from different plans to update their data.
No, at this point Symphony is not consumer-facing, as our top priority is to improve the quality of each health plan’s provider information. Symphony is the back-end database that will consolidate and reconcile provider data and send it back to plans and other multi-plan directories to populate their consumer-facing provider directories.
Consumers rely on provider directories when making decisions about which plan to choose, which providers to see, and even where to go for their appointments. Inaccurate provider directories are one of the biggest pain points for patients making healthcare decisions—costing time, money, and even potentially impacting health outcomes. Symphony will help to ensure that health plans are able to consistently deliver accurate information to consumers in an efficient and cost-effective manner.
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 $200M in programs that strengthen the healthcare delivery system in California, including the development of a statewide, centralized provider directory database.
While BlueShield is providing initial funding of $50M for the initiative, the goal is for Symphony Provider Directory to become a financially self-sustaining initiative by 2023.
Recognizing that stakeholder engagement is critical to the success of this initiative, in 2016, the California Department of Managed Health Care (DMHC) and Blue Shield collaborated to guide a multi-stakeholder process that identified organizations that might host the utility. After a Request of Information and round of interviews with several potential organizations, the advisory committee selected IHA as the host to lead the creation of the Symphony Provider Directory.
The selection process mentioned above resulted in the creation of the California Provider Directory Summit and a multi-stakeholder advisory committee of health plans, providers, consumer groups and regulators in 2016. This group worked to define priorities, functions and governance requirements for the statewide provider directory, and to evaluate organizations as potential hosts for this vital resource.
To select a technology partner for this initiative, IHA canvassed the provider data management industry and reviewed more than 15 companies to select the final three vendors who were evaluated by internal committees, with oversight from industry leaders and IHA’s executive committee.
Potential technology vendors were assessed for technology, usability, price, industry reputation, customer support capabilities and meaningful market traction in California, which resulted in the selection of Gaine Healthcare’s market-leading health plan-focused technology, and Availity’s provider organizations-focused platform. The final result of this partnership? A centralized, standardized platform for provider information in California that pulls from the best of both worlds.
We selected Gaine Healthcare/Availity due to their ability to meet the business and technical requirements, their extensive experience in provider data management in California, and their ability to support IHA’s business plan.
The selection was made through a thorough canvass of the industry and market reviewed by internal and external committees; with oversight and final decision-making from IHA’s Executive Committee. We looked not only at the vendor’s technology, usability, price, and industry reputation, but also for strong customer support capabilities and meaningful market traction in California.
Vendors invited to submit an RFP were allowed to partner in order to meet all business and technical requirements. The two companies together offer complementary provider data management solutions and work to connect providers, provider organizations, and health plans. Together, they will make the Symphony Provider Directory more effective for all stakeholders.
Gaine Healthcare/Availity are responsible for developing and supporting the technology and product. Gaine Healthcare/Availity will partner with IHA to build a product that will address the many different types of users in California and will provide extensive customer and technical support to help users adopt this new technology and provider directory data management process.
We have and will continue to make it a top priority to review all available technologies. We will continue to look at applications for blockchain, AI, crowdsourcing, and other established and emerging technologies to ensure that Symphony uses the right technology to continue to innovate and improve the quality and management of provider, encounter and other types of data.
Collaboration among vendors, health plans, health systems and providers is key to successfully solving this industry-wide problem. The Symphony Provider Directory expects to work with vendors who are also addressing this need. Symphony will be a central “source of truth” for provider and provider-plan data.
While Symphony will not handle the full scope of what is required for compliance, it will make it easier to achieve compliance with SB 137, Medicare Advantage, and Medi-Cal requirements.
The Symphony Provider Directory will take on significant parts of the provider data management process for plans and providers—effectively removing the needs for those internal workflow processes—but plans will continue to be responsible for achieving full compliance for the parts of the process that Symphony does not cover. (i.e. plans are responsible for using the data from Symphony to populate their own online consumer-facing directories, etc).
The Symphony Provider Directory will significantly improve providers’ efficiency as they will update all plan information in one place at one time.
We plan to launch education and outreach campaigns to help providers understand what they need to submit and by when so that their processes are ultimately streamlined, and they do not get inundated with requests for their information. Consistent education and outreach will be essential to help providers understand what is needed and how to use Symphony to save time and resources.
The Symphony Provider Directory will make several attempts to contact non-responsive providers. If a provider is non-responsive after exercising all of Symphony’s outreach processes, the Symphony Provider Directory will provide an auditable trail of every interaction and flag these providers so that the plans can take the necessary steps required by SB 137 or other regulatory requirements.
The Symphony Provider Directory will validate and verify provider data, including which providers are in which networks. If conflicting data exist, Symphony will notify plans and providers and work with both to resolve the conflicts.
No, not during the initial phase of Symphony’s development. Although we recognize that the core provider data set is consistent across multiple use cases such as credentialing, the initial launch will focus on the data for plan’s consumer-facing provider directories (i.e. practice location, products accepted, and whether or not providers are accepting new patients).
We anticipate that we will expand the capabilities of Symphony in the future, but to be successful, we are limiting the initial scope and focusing on providing accurate provider data first.