This newsletter is a part of our 2023 Stakeholders’ Series. Through this channel you’ll get industry, program, and IHA-wide insights, in a more tailored and timely way.
Availity CEO and DMHC Director applaud Symphony progress during fireside chat
On September 20, 2023, IHA hosted an interactive session with Russ Thomas, Availity CEO, and Mary Watanabe, the Director of the California Department of Managed Health Care, and IHA board members (representing Symphony organizations). The informal discussion, held at Covered California’s offices, was facilitated by Jeff Rideout, IHA president and CEO. During the session, Thomas and Watanabe addressed progress to date, challenges faced, and future considerations for the statewide solution.
Russ Thomas started off the discussion by announcing Symphony’s near 50% completion of its “critical mass” target.1 “Availity has made a good pivot over the last six months,” stated Russ. “If you look at the rise of active NPIs in Symphony, it’s gone from 40,000 in January 2023 to 280,000 in August 2023, which is almost halfway towards Symphony’s critical mass target.” Russ went on to detail the progress of health plans being onboarded to Symphony, “The goal of Availity is to have everyone onboarded by the end of next year.”
Mary Watanabe responded by praising Symphony’s progress. “I’m really pleased to see the progress made in terms of the number of plans and providers that are engaged. This is exciting for someone who has been part of this from the beginning. Our intent has always been, with enough participation and momentum, to drive the industry to a centralized database. We are moving in the right direction.”
While significant progress has been made toward Symphony’s development, IHA and Availity acknowledged the patience required of clients who await onboarding to the platform. The task of transitioning plans and providers, with often decades-old legacy systems, to a standard process, while navigating the complexities and questions surrounding refinement of their data, has presented both challenges and opportunities. “This is a decades long industry problem that requires time to solve,” stated Andrea Rodgers, Consultant. “At the end of the day, it’s going to take time for us to get there.”
Ongoing progress toward onboarding California’s unique providers and health plans serves to further stabilize and strengthen Symphony, driving value for all clients through increased scale, ease of use and ongoing data quality improvements. We look forward to reporting our Q4 progress in the months to come.
1. Critical mass of 616,000 based on DMHC’s 2020 risk bearing organization analysis. Critical mass target set through Blue Shield contract with IHA in Symphony 2021 Grant Amendment.
Data Quality
Symphony contributes meaningful refinements to provider data
High-quality provider directory data is the foundation for achieving accurate provider directories. Over a 30-day period, Symphony noted improvements in data quality by refining over 96,000 data elements, representing 12% of the total data elements submitted from participants.
Of those 96,000 refinements, several noteworthy data quality refinements include:
45% of updates to provider name
12% of updates to service location address
7% of updates to service location phone number
This represents only three of the 300+ data elements that Symphony collects from its participating organizations. While this level of detail supports regulatory and organization specific needs across the state, it can make measuring and quantifying data quality a complex process.
Consumer impact drives decision on data quality reporting
During the Q3 Data Governance Committee (DGC), Symphony recommended an initial approach to measuring and quantifying data quality using attributes that have the greatest consumer impact.
For a consumer to select a physician and access timely care; network participation, panel status, phone number, and office location are crucial information. The following critical data elements will be measured as part of Symphony’s initial data quality reporting, which will be available to clients live on Symphony powered by Availity later this year:
Provider Not Practicing (Excluded, Deceased, Retired, Deactivated NPI or License)
Provider Not at Correct Locations, Incorrect Phone Number
Providers with Invalid Contract Information (Network, Line of Business, Plan Type)
Providers with Invalid Contract Information (Network, Line of Business, Plan Type)
Following the committee’s approval, the Symphony team is getting to work on developing this report. For clients currently submitting data to the new Symphony platform, your Client Success Manager will soon share a more detailed release timeline. All other clients will learn more during their scheduled implementation.
Symphony achieves program independence, signifying program’s growing stability
Symphony initially launched its centralized platform in 2019 with the support of a $50 million grant from Blue Shield of California. Jacqui Darcy, General Manager of the Symphony Program, recently announced Symphony’s graduation from a grant funded program to one that is independently run.
“I am pleased to announce that Symphony now fully operates with self-funded revenue,” stated Jacqui. “This shift to independence signifies Symphony’s stability and a commitment to carrying out its goal of being the primary solution for improving California’s healthcare provider directories.”
Harmonizing data submission
Symphony currently receives custom data files from each provider organization and health plan it contracts with, meaning no two files are formatted or structured in the same way. As Symphony looks to improve its ability to scale, a key piece of the puzzle is standardizing the format in which data is submitted to Symphony.
A standard inbound format will enable Symphony to:
Incorporate regulatory and other statewide data requirements
Streamline data submission and simplify data matching techniques driving improved quality
Enable faster implementation timelines so Symphony participants can begin exchanging data more expediently
When will Symphony require a standard inbound format?
All Symphony participants contracting from Q3-2023 forward will be required to use the Symphony Standard Inbound format. Covered CA (CCA) expects all participating Qualified Health Plans (QHPs) to migrate to the Symphony Standard Inbound format in 2024 to enable seamless data exchange between QHPs and CCA via Symphony. Our Client Service Managers will work with all clients currently submitting their data using a custom inbound format to develop a migration plan and provide resources needed to adopt the Symphony Standard Inbound format in the future.
Stay tuned for more information in future communications.
Upcoming Events
CAHP Conference October 23-25, 2023 | Desert Springs, CA
Q4 IHA Data Governance Committee, November 16, 2023
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