Introducing the 2023 Stakeholders' Series. We’re bringing a whole new approach to IHA stakeholders’ conference for 2023. Instead of a single, annual conference, we’reintroducing the 2023 Stakeholders’ Series. You’ll still get industry, program, and IHA-wide insights, but in a more tailored and timely way. This Symphony newsletter is the launch of the series for Symphony related updates.
Highlights
Symphony progress to date
Orchestrating an industry-wide movement of Symphony’s scale requires significant time, dedication, and commitment from its clients and surrounding community. With the support of California’s Department of Managed Health Care, IHA and Availity are focused on resolving the global data model and mastering policy issues uncovered during Symphony’s launch in Q4 of 2022. To-date, the Symphony platform has made significant progress toward improving the quality and accuracy of provider directory data, including:
Execution of 10,500+ data quality improvements across provider, service location, and facility domains.
Resolution of 50+ issues encountered with initial implemented provider organizations and health plans.
Delivery of automated, file-based attestation for clients live on Symphony.
Earlier identification and resolution of global issues will serve to improve Symphony’s mastering process, paving the way for higher-quality deliverables and more streamlined client implementation.
IHA is grateful to its clients for their ongoing support and patience throughout this process. Symphony clients will continue to receive regular updates on the program’s progress and work being done to accelerate client implementation timelines. For more information, please contact your dedicated Client Success Manager.
IHA testifies at U.S. Senate Committee on Finance hearing to reduce the prevalence of ‘ghost networks’
The U.S. Senate Committee on Finance hosted a hearing on May 3, titled “Barriers to Mental Health Care: Improving Provider Directory Accuracy to Reduce the Prevalence of Ghost Networks.” IHA CEO, Jeff Rideout, MD, was one of five witnesses invited to testify during the hearing.
Dr. Rideout presented the Symphony platform as a novel, industry-backed solution designed to help health plans and providers share, reconcile, and validate provider accuracy, while reducing administrative burden. He cited the Council of Affordable Quality Healthcare (CAQH) 2019 survey that determined updating directory information costs practices roughly an average of $998, per month.
Additionally, he used key findings from Symphony’s experience to outline a solution to the current nationwide problem, including the importance of standardization, alignment of stakeholders, and alignment of complex state and federal regulations. He stated that better transparency, and establishment of a single source of truth, state-by-state or nationally, is critical to creating more accurate provider directory data.
Prior to the hearing, Dr. Rideout submitted written testimony to inform the dialog and answer questions regarding Symphony’s experience in tackling provider directory data accuracy.
Jeff Rideout, MD joins Ms. Keris Jän Myrick, MBA, MS, Vice President of Partnerships, Inseparable; Dr. Jack Resneck Jr., MD, President, American Medical Association; Dr. Robert Trestman, MD, Professor and Chair, Carilion Clinic and Virginia Tech Carilion School of Medicine Department of Psychiatry and Behavioral Medicine; and Ms. Mary Giliberti, JD, Chief Public Policy Officer, Mental Health America
Need to know
Looking ahead: new program enhancements
In March of 2023, the IHA Data Governance Committee approved the following staff recommended changes for Symphony’s mastering policies and data model:
Mastering policies and health plan inputs: No Master value will be determined for an attribute where Provider or Reference data is unavailable, and Health Plan clients will be returned their own data values in extracts or reports.
Impact: This approach will prevent Health Plans from receiving data updates that have not been attested to by a provider. This change is more relevant during our implementation process as we have many cases where Provider data is supplied only from Health Plans. As Symphony onboards more Provider Organizations, the mastering policies would prioritize Reference or Provider supplied data as designed.
NPI Attributes: Data will be captured at the TIN + Provider + Service Location level, with one Supervising Physician NPI per TIN + Provider + Service Location.
Impact: This optional data field is only available to providers with mid-level practitioner specialty taxonomies. This approach will help overcome the limitations of the previous Symphony model that included only being able to capture the NPI for one supervising physician per Provider + Service Location with no validations to restrict or require gathering this data for mid-level practitioners.
Proposed Assembly Bill 236
In January of this year, Assembly Bill 236 (AB 236) was introduced, building on existing laws, including SB 137, that require health plans to audit their own provider directories per standards set by DHCS. The bill ties existing requirements to accuracy benchmarks, including:
60% accurate directories by January 1, 2024
80% accuracy by January 1, 2025
90% accuracy by January 1, 2026
95% accuracy by January 1, 2027
AB 236 would also require these audits be done annually and verification by health plans of provider directories for accuracy of all required information. Health plans who fail to meet benchmarks will be subject to administrative penalties for each inaccurate listing in its directory.
The bill, initially presented on March 14, passed the Assembly Health Committee, with Symphony’s statewide provider directory mentioned as a key industry solution already in operation to support its implementation. During the Assembly Appropriations Committee hearing on April 19, AB 236 was placed on the Suspense File. Since this is the start of a two-year legislative session, AB 236 may become a two-year bill.
Join IHA for its first Health Policy Update webinar on Tuesday, June 20, from 9 - 10:30 am PST. During the webinar, we’ll share updates and insights on key legislative and regulatory activity that impacts our industry.
The webinar is part of IHA’s 2023 Stakeholders’ Series, our outreach program that includes more than 400 stakeholders from health plans, provider organizations, health systems, and purchasers. The webinar will cover several topics, including:
Legislative and regulatory activities including new health equity metrics, statewide data exchange efforts and improvements, primary care spend investments, and an overview of significant Medi-Cal reforms
An update from the state’s new Office of Health Care Affordability and key stakeholders
A review of activities that aim to improve provider directories
You’ll also hear from a panel of industry leaders, consumer advocates, and state regulators. They will share their perspectives on what is required to develop a more transparent, equitable, and affordable system of care and how current developments and initiatives are working to make that possible.
Stay tuned for details about speakers and how to register!
Integrated Healthcare Association, 180 Grand Avenue, Suite 1365, Oakland, CA 94612
