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May 2016 - IDC PlanScape - Doc # US41242516

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

Table of Contents

IDC PlanScape Figure

Figure: IDC PlanScape: Directory Accuracy and Network Adequacy

Executive Summary

Why Is Directory Accuracy and Network Adequacy Important?

Mandated Compliance Demanding Frequent Outreach/Validation: With Specific Mandatory Directory Fields and Minimum Network Adequacy Requirements

Address the National Tide

Retain the Payer’s Ability to Narrow Networks by Being Transparent with Network Adequacy to Legislators and Regulators

Be Ready for Increased Network Adequacy and Directory Quality Audits

Differentiate the Brand: Address Consumer Engagement Desires

Set the Table for Telemedicine/Virtual Care Network Design Alternatives and Changes to Network Adequacy Variables

Network Design Changing

Network Adequacy Variables Changing

What Is Directory Accuracy and Network Adequacy?

Provide Current, Accurate Online, Electronic, and Paper Directories to Consumers

Comply with Federal, State, and Industry Mandates in This Area

Demonstrate Network Adequacy to Legislators and Regulators

Optimize Administrative Cost Addressing These Requirements

How Bad Is the Problem?

Why Is There a Problem?

Who Are the Key Stakeholders?

How Can My Organization Take Advantage of Directory Accuracy and Network Adequacy?

Tier the Provider Data: Determine Data Tiers and the Costs of Data Quality, Separate Core Directory Data from Core Operational Data and from Quality-Would-Be-Nice-to-Have Data

For the Directory Data, Adopt a Collective Noncompetitive Mindset: Is This Data Really a Competitive Advantage? Is It Worth the Cost of Doing It Alone?

Use a Strong Data Model and Data Architecture Ensuring One System of Record

Execute a Comprehensive Baseline, Reactive, and Proactive Approach to Maintaining the Provider Data Ecosystem

Essential Guidance

Related Research

Referencing Documents

Related Links