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May 2016 - IDC PlanScape - Doc # US41242516

IDC PlanScape: Directory Accuracy and Network Adequacy — For Payers, the Time Has Come

Author: Jeff Rivkin
Research Director, Payer IT Strategies

Abstract

This IDC PlanScape offers guidance to increase the effectiveness of directory accuracy and network adequacy initiatives.

“Customer engagement with payers starts day one with the patient seeing if their set of doctors is local, in-network, available for new patients, speaks their language, and is available to them conveniently. If that consumer information is later found to be inaccurate or inadequate, a payer’s brand is tarnished forever and now with the increase of the individual marketplace, consumers will go elsewhere,” states Jeff Rivkin, research director for Payer IT Strategies at IDC Health Insights. “High-visibility rulings have penalized over a quarter million dollars in fines to two commercial payers for ‘misleading’ consumers about their networks (with one resultant $15 million class-action settlement), CMS has imposed $25,000 (per beneficiary) fines for (Medicare Advantage [MA]) inaccuracies, and the newly engaged state legislatures threaten new mandates and fines. Most importantly, the new consumer engagement paradigms are driving payers to finally pay attention to the directory ecosystem.”

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