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Provider-network data is revolutionizing health & benefits technology 

Posted on by Ideon

Summary

Provider-network data is powering today’s most innovative health and benefits technology, from healthcare navigation and provider search apps to telehealth and analytics platforms.

 

Provider-network data is the backbone of today’s most advanced technology platforms and apps in the health and benefits space. From doctor search apps to appointment scheduling and healthcare analytics, countless digital experiences rely on this critical information to serve the needs of tech-savvy consumers and the modern workforce. 

In this blog, we’ll explore five ways health and benefits innovators are leveraging provider-network data to deliver exceptional user experiences. 

But first, what exactly is provider-network data? 

At its core, provider-network data encompasses detailed information about doctors, facilities, hospitals, and other healthcare providers, along with the insurance networks they participate in. A comprehensive dataset includes: 

  • Name of provider 
  • NPI number 
  • Provider specialty 
  • Address of the provider 
  • Phone number 
  • Insurance networks in which the provider participates 
  • Hospital and physician group affiliations 
  • Whether the provider is accepting new patients 

While this information is often available through insurance carriers’ provider directories, platforms can now access it more efficiently, from a single source like Ideon. Offering this data via an API makes it easier for technology companies to integrate it into their products. 

As access to provider data has expanded, there’s been a surge in innovation within the digital health, healthcare navigation, and benefits technology industries. At Ideon, we’ve witnessed firsthand where this innovation is thriving, all rooted in better availability of high-quality data. 

Below are five types of companies where provider data is driving significant advancements. 

Healthcare and Benefits Navigation 

Healthcare navigation platforms like HealthJoy, Healthee, and Castlight Health streamline understanding and utilizing employee health benefits. They offer easy access to insurance details, compare benefits options, and provide personalized recommendations, empowering employees to make informed healthcare decisions. 

A standout feature is integrating provider-network data, simplifying the process of finding in-network doctors. Advanced tools like AI-driven chatbots use data to guide employees to quality, cost-efficient providers. 

Plan Selection and Enrollment Support 

Platforms like PlanSource and Benefitfocus simplify selecting health plans and benefits, making the enrollment process efficient and more informed for employees. These platforms allow users to compare health plans and benefits, helping them choose the best coverage based on clear, concise information. 

Provider-network data plays a crucial role by guiding employees toward plans that include their preferred doctors, ensuring continuity of care. By incorporating this data, these platforms offer personalized plan recommendations tailored to employees’ healthcare needs. 

Telehealth 

Telehealth platforms such as Teladoc and Amwell have transformed healthcare access by enabling remote consultations with doctors and specialists. These platforms offer a convenient way to receive medical care via video calls, phone calls, or messaging, reducing the need for in-person visits and making healthcare more accessible. 

Integrating provider-network data ensures users can consult with doctors covered by their insurance, avoiding unexpected costs and facilitating seamless care. And, if a referral to a hospital or specialist is needed, the telehealth platform directs care to in-network options. 

Provider Search 

Provider search apps like Zocdoc and Sesame are essential for finding and booking appointments with in-network healthcare providers. These user-friendly apps allow users to search for doctors by specialty, location, and availability, offering detailed provider information, including patient reviews and ratings. 

For these platforms, provider-network data helps users find doctors who accept their insurance. This saves time and eliminates the frustration of out-of-network surprises, providing personalized search results. 

Healthcare Analytics 

Healthcare analytics platforms like Clarify Health offer crucial insights for better decision-making and health outcomes. By analyzing numerous healthcare datasets, these platforms empower health plans and other organizations to identify trends, predict outcomes, enhance care quality, reduce medical spend, and build the best networks. 

* * * 

Provider-network data is the foundational element driving all these user experiences, ensuring that platforms can deliver accurate and personalized information. Today, platforms no longer need to work with individual carriers or aggregate data from multiple sources. Instead, they can leverage partners like Ideon, which deliver provider-network data via a standard API. This streamlined access to up-to-date provider information enhances the ability of these platforms to deliver modern experiences to users.

Test the industry’s most accurate provider-network data

Digital health, healthcare navigation, and analytics platforms rely on Ideon for the highest quality provider-network data. Download a data sample below.


Five ways your provider-network data goes wrong—and how to avoid them

Posted on by Ideon

Summary

High-quality provider-network data allows healthcare platforms to deliver an optimal user experience. Discover the common pitfalls—and learn how to avoid them—to ensure your provider data is up to par.

As a leader in healthcare navigation, digital health, or InsurTech, you’ve likely invested heavily in developing an intuitive platform. Key to that effort is the provider look-up feature, enabling users to find in-network providers in order to make informed, cost-efficient healthcare decisions. 

At the core of this feature is provider-network data: the information about doctors, hospitals, and insurance networks that users are searching for. But while many platforms work with data partners for easy provider data integration, not all solutions are created equal.

Below, we outline exactly what can go wrong with your provider-network data—and how to avoid each pitfall.  

 

The data is incomplete.

Incomplete data means poor search results. Whether your end-users are looking for the basics like provider names, addresses, or specialities, or more detailed information like network IDs or network tiers, it’s all mission-critical information for them. 

All of this means that the breadth of provider-network data can be the pivotal differentiator between a great solution and a passable one. 

How to avoid the pitfall: Identify the information you need on your platform. Does the API solution you’re looking at (or already using) provide everything you need? The answer here will give you a good idea of whether you’ve found the right partner—or need to move on.

And remember: robust data will let users search providers by network and/or plan, and search networks by carrier. Typical use cases include selecting a primary care provider during open enrollment, confirming that a physician referral falls within a patient’s network, and facilitating app-based scheduling of physician appointments. 

The data is inaccurate.

Comprehensive data is only an edge if it’s also correct. Inaccurate data—say, regarding physician network participation, specialties, or addresses—can have a significant downstream effect, resulting in billing errors, denied claims, and the person-hours required to rectify them. 

How to avoid this pitfall: Run a review of your provider-network solution—or ask a prospective data solution provider for a sample of their data to test. 

Compare what the API is giving you with data you already have. Does the solution have validation capabilities and procedures to ensure that data is verified and up-to-date? Does it have meaningful measures in place to detect and reconcile discrepancies?

The answers will give you a good idea of whether the solution is the right one for your platform.

The data isn’t timely.

What if the data your users are seeing is both complete and accurate—but out of date? That’s an inaccuracy in its own right, and one that is avoidable only if you ensure your team is following carrier data changes on their discrete schedules. 

How to avoid the pitfall: An effective provider-network data solution will update data from carriers and other sources on a regular cadence, often weekly, monthly, or somewhere in between. Ensure that your solution accounts for the fact that carriers provide their data on their own schedule, and (critically) has an automated process in which it ingests, aggregates, and standardizes the data to ensure the freshest data possible.

The solution isn’t scalable.

If you are seeking to aggregate data from multiple carriers, it is crucial that you select a provider-network data solution that is capable of evolving and scaling right alongside you. Without that capability, integrating to each carrier will become prohibitively cumbersome. 

How to avoid the pitfall: Run a check of your current solution or ask a prospective one how they would handle a multi-integration scenario, and the timeline on which they can get a new carrier online with you. If the answer is more than a couple days, it’s time to move on. 

The solution lacks strong carrier relationships.

The key to accessing complete, timely, and accurate data is relationship-based buy-in from carriers. Without it, you are essentially back at square one. 

Whether you have these or need to build more in order to scale, your provider-network data solution must be your ally on this in order to ensure you are getting access to the data on which your platform runs, as soon as you can.

How to avoid the pitfall: Ask the solution you have or are considering for a list of carriers with which they have relationships—and to rate the relationships as strong, good, fair, or poor.

***

The process of testing a provider-network data solution can be intense, with limited time to make a decision that will shape an organization’s ability to meet customer and end-user expectations for years. These five pitfalls—and mitigating actions—will help product leaders and data strategy decision-makers to choose the best solution for their needs, leaving more time for cost-benefit analysis and other evaluation. 

Interested in learning about Ideon’s provider-network API? Contact us here.

Test the industry’s most accurate provider-network data

Digital health, healthcare navigation, and analytics platforms rely on Ideon for the highest quality provider-network data. Download a data sample below.


Five datasets powering today’s healthcare navigation platforms

Posted on by Ideon

Summary

Healthcare navigation platforms are transforming how employees make informed healthcare decisions. To do so, they’re integrating data elements like provider network data, doctor quality metrics, cost information, patient reviews, and claims data.

Over the past few years, three trends have intersected: healthcare costs increased, the healthcare system became more complex, and digitally native employees started expecting employers to provide technology for HR and benefits tasks.

Enter healthcare navigation platforms — digital tools that guide employees to better, more informed healthcare decisions based on cost, quality, and other criteria.

These platforms provide a wealth of information on doctors, hospitals, prescription drugs, and medical procedures. They also help employers to manage their healthcare costs by providing transparency into the pricing and quality of healthcare services.

Of course, offering an intuitive, modern user interface is essential for any healthcare navigation platform. But the breadth and quality of data behind the scenes, powering the features, often have the biggest impact on the overall user experience.

Here are five key data elements that some leading navigation platforms have integrated into their experience.

Provider network data
This includes information about the doctors and hospitals in a particular health plan’s network, including provider locations, specialties, and more. This is a foundational dataset, providing employees with detailed information about the PCPs and other healthcare providers in their network. Navigation platforms can help employees to make more informed decisions about where to receive care, as in-network providers are usually more cost-efficient than out-of-network.

Provider quality data
This covers the quality of care provided by different doctors and hospitals, as well as patient satisfaction ratings. This may also include outcome-based metrics. Platforms integrate provider quality data into their experiences to help employees choose healthcare providers that are more likely to provide excellent care.

Cost information
This is data about the cost of different medical procedures, prescription drugs, and other healthcare services. By providing employees with transparent pricing information, these platforms can help them shop for healthcare and make more cost-effective choices.

Patient reviews
Reviews and ratings of different healthcare providers from other patients who have received care from them. Armed with this information, employees can find healthcare providers that are more likely to provide a positive patient experience.

Claims data
Information about the healthcare services that employees have received, including the cost of those services and any out-of-pocket expenses that they may have incurred. By giving employees access to claims data, these platforms can enable them to better understand their healthcare benefits and how to use them.

All of these data sources are crucial for powering the new age of healthcare navigation platforms. By aggregating this data and presenting it to employees in an easily understandable format, these platforms can help to demystify the healthcare system and empower employees to make better decisions, resulting in significant cost savings for employers and improved health outcomes for employees.

For navigation platforms, collecting and integrating all of this data from disparate sources may seem like a colossal undertaking, but that’s generally not the case. Much of this information is now readily available via APIs. For example, Ideon offers structured, normalized provider-network data to navigation platforms via an API.

There are several healthcare navigation platforms on the market today, each with its own unique set of features and capabilities. Some examples include Healthcare Bluebook, Garner Health, HealthJoy, Accolade, Castlight Health, and others. Though their user experiences vary significantly, all rely on the power of data.

Test the industry’s most accurate provider-network data

Digital health, healthcare navigation, and analytics platforms rely on Ideon for the highest quality provider-network data. Download a data sample below.


Ideon Names Benefits and Technology Leader Steve Swad as CEO

Posted on by Ideon

Co-founder Dan Langevin promoted to President and Chief Technology Officer

NEW YORK — Ideon, the leader in data and connectivity solutions for carriers and benefits technology platforms, today announced Steve Swad as its new Chief Executive Officer, effective immediately. In a complementary move, Ideon co-founder Dan Langevin has been promoted to President and CTO.

Swad brings decades of C-level leadership experience from the employee benefits industry and various high-profile technology and media companies. Previously, Swad led Benefitfocus, a top benefits administration platform, as its CEO before its acquisition by Voya Financial. Swad’s impressive career also includes roles as CEO of Rosetta Stone, COO of Apptopia, and CFO positions at Vox Media, Comverse Technology, and AOL.

Langevin, co-founder of Ideon and its CTO since 2014, has played a pivotal role in shaping the company’s technology and advancing its business. He has emerged as a prominent figure and innovator in the benefits sector, with a focus on API development and bringing modern efficiency and automation to the industry. His appointment as President and CTO reflects his vital contributions to Ideon’s technology and his influence on the company’s broader vision.

“I’m thrilled to join Ideon due to the company’s innovative products, exceptional leadership team, and the significant opportunity we have helping the benefits industry modernize its technology,” Swad said. “Ideon stands out for its potential to transform benefits data exchange, unite this intricate ecosystem of stakeholders, and enhance the benefits experience for millions of people. Also, I’m excited to partner with Dan, whose expertise and vision have been instrumental to Ideon’s journey and the industry at large.”

“I’m deeply honored by this new role and excited for Ideon’s future,” said Langevin. “Working alongside Steve, I’m confident we’ll lead Ideon to even greater success. Our shared vision and complementary skills will unlock new opportunities and deliver unprecedented value to our customers.”

These leadership updates mark a significant milestone for Ideon as it continues to revolutionize how carriers and benefits technology platforms connect and exchange data. Over the past year, in addition to broadening its product suite, Ideon has secured contracts with new partners and grown relationships with industry leaders including Guardian, Pacific Life, Beam, Rippling, BambooHR, HealthJoy, Gusto, and Connecture. Under the strengthened leadership structure, Ideon is poised to accelerate its progress and expand its impact on modernizing the health and benefits industry.

About Ideon

Ideon is the way health insurance carriers and employee benefits providers connect with technology partners to deliver seamless consumer experiences at every stage of the member journey. Ideon is not the websites or apps one uses to choose a plan or find a doctor. It is the infrastructure, the ‘pipes,’ that simplify the complex exchange of quoting, enrollment, and eligibility data between carriers and the technology partners so that they can, in turn, deliver health and employee benefits to hundreds of millions of Americans everyday. Ideon’s APIs transmit billions of data points between InsurTechs and insurance carriers, powering an amazing benefits experience for all. To learn more, please visit: www.ideonapi.com.

Ideon Insights: Pacific Life execs on building a digitally-native benefits division

Posted on by Ideon

Welcome to Episode 4 of Ideon Insights, our monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In this episode, we talked with two leaders from Pacific Life’s new workforce benefits division, Bram Spector (CFO) and TJ Clayton (Head of Partner Management).

In this Q&A, Bram and TJ discuss building a digitally-native, startup-like benefits provider, backed by the resources and reputation of a 155-year-old insurance giant. They also explain why the benefits experience is ripe for digital innovation, how digital connectivity fueled Pacific Life’s go-to-market strategy, the role of Ideon, and their vision for the future.

Watch the full episode of Ideon Insights here. Below we’ve highlighted key moments from the conversation.

IDEON: Why did Pacific Life enter the benefits industry?

BRAM SPECTOR: Pacific Life has legacy and a track record of incubating and building new businesses. Our corporate strategy team spent a couple years evaluating options, various markets that we weren’t in previously, and ultimately made the decision that employee benefits was the place where we wanted to invest in building a new business.

Our strategy started by assembling a team of folks from across the group insurance industry who had spent the last 10, 15, 20 years of their careers in carrier roles and wanted an opportunity to deliver exceptional experiences to customers. We built a team that was focused on solving our customers’ biggest issues, then we did a ton of research to validate the pain points today across the industry.

We spent a lot of time challenging ourselves to understand why our competitors have not been able to solve those challenges. And then we architected our strategy around a series of experiences that are designed to make our customers’ and stakeholders’ lives better.

IDEON: Walk us through your initial launch strategy… what were your priorities?

BRAM SPECTOR: Ultimately, we decided to build the business based on a couple of key principles. One, we want to operate like a startup — agile, move quick, use an MVP-based approach to get to market. And two, we’re focused on building a digitally-native workforce benefits business. We’re also thrilled to launch with three technology partners: Employee Navigator, ADP, and Selerix.

IDEON: What does it mean to be a digitally-native benefits provider?

TJ CLAYTON: When we think about being digitally native, the key is not to just be digital for digital sake. What are the pain points, the friction points that brokers and employers experience all day, every day? That’s what we want to solve with a digitally-native approach.

What are the pain points around billing, around commissions, around setting up cases, enrollment, and file feeds? What are the challenges that make this industry what it is, and how do we turn those things on their head via a digitally native experience? We set out to solve problems, not to just put a digital label on a new logo and a new company.

BRAM SPECTOR: We’ve got the benefit of starting with a completely blank slate from an architecture perspective. We’re making sure we take advantage of that opportunity to really architect our experiences and our business processes in a way that supports our customers.

IDEON: What parts of the benefits experience did Pacific Life focus on initially?

BRAM SPECTOR: We heard resoundingly that the industry’s billing experience is terrible. It’s challenging, and frankly, it shouldn’t be. Onboarding, or customer implementation, is another issue that customers consistently have said is a pain point and a challenge. So we’ve got the opportunity to set a great first impression if we do that implementation right, and to set ourselves up for a successful customer relationship.

IDEON: From an API, digital connectivity standpoint, where have you prioritized development?

TJ CLAYTON: We’ve invested significantly in building API connections with key technology partners. The functionality that excites me the most is that first initial step, the case set up. We’re able to set up a case in 30 minutes or less with a click of a few buttons and an API pulling all of that information right out of Pacific Life’s core system, right into our partner system.

What used to be days, sometimes weeks of manually keying in eligibility rules and rates, class mapping, not to mention the error-prone nature of manual data entry — all the things you’d have to do just to get someone ready for enrollment — we’re making it happen almost in real-time.

IDEON: How does partnering with Ideon fit into Pacific Life’s digital connectivity strategy?

TJ CLAYTON: For us, it’s about getting out into the market quicker with more partners. If there was a time where we had a disconnect between our shared values, technically, and someone else’s, Ideon can help bridge that gap.

Obviously, we prefer to receive data via API, because we believe that that’s the way of the future and that’s going to differentiate us. If a partner is not ready to send data in that manner, but there’s other reasons why we should work with that partner and Ideon can help bridge that gap in terms of enrollment data exchange, well, then there’s a great fit right there. So for us, choosing to partner with Ideon was about helping us get out in the marketplace with more partners, in a technically advanced way. 

IDEON: Why is offering a great digital experience so important in the benefits industry?

BRAM SPECTOR: We want to simplify that experience so members can spend more time taking care of themselves, taking care of their families, instead of filling out endless forms to get their claims fulfilled.

Additionally, we’re looking to simplify the lives of brokers. While a lot of our digital experiences aren’t designed specifically for them, our connectivity strategy is designed to help make their lives easier. We’re simplifying the administration of benefits so that they can focus their time, their energy, and their limited capacity on helping their customers make the right decisions around how to protect their employees.

IDEON: What’s next for Pacific Life’s Workforce Benefits Division?

TJ CLAYTON: More partners, but not every partner. When I think about where we’re starting: no legacy technology, no legacy tech stack, the ability to have APIs throughout the whole value chain, but who’s ready to go on that journey with us? It’s not everyone. We want to bring the industry and bring the ecosystem along with us.

 

Stay tuned for new episodes of Ideon Insights each month. Subscribe to our newsletter below to stay in-the-know about Ideon and receive our latest content directly to your inbox.

Ideon Insights: Guardian’s Josh Weaver on APIs and digital partnerships

Posted on by Ideon

Welcome to Episode 3 of Ideon Insights, our monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In this episode, we sat down with Josh Weaver, Head of Digital Ecosystem & Partner Management at Guardian Life, a leading provider of life, disability, dental, and vision insurance and other group benefits.

In this Q&A, Josh explains how Guardian leverages technology to enhance the benefits experience, their focus on API connectivity and strategic tech partner selection, and their collaboration with middleware solutions like Ideon. He also dives into Guardian’s real-time quoting capabilities, winning business in today’s small group market, and more.

Watch the full episode of Ideon Insights here. Below we’ve highlighted five key moments from the conversation.

IDEON: How do you evaluate and choose benefits technology partners?

JOSH WEAVER: To me, it all starts with value. Guardian is really focused on the overall well-being of our plan holders. So really, the first piece is, you want partners that are focused on the same thing. Are these partners focused on really improving the experience for our plan holders? Number two, we think about the entire lifecycle of a member, and really how do we, through connectivity, engage with these partners—API preferred—to create a better experience than Guardian could provide alone.

 

Do you select partners based on their connectivity capabilities?

If you’re not an API-enabled partner, there has to be a very unique value prop you’re bringing to market for us to want to partner with you in a commercial or a more strategic manner. If I fast forward five, six, seven years from now, I think you’re going to see API connectivity is replacing EDI.

So really, if you’re not on a modern technology stack, then you’re not necessarily the companies that we’re looking to partner with moving forward. 

 

​​Does connectivity impact which carrier a group chooses?

Benefits are still an extremely important part of the conversation. But it’s also around, as an employer, how does working with Guardian make my life easier? Do they work with my benefit administration platform? Do they offer online EOI or EOI API?

You’re seeing plan holders and brokers, when they’re recommending carriers to clients, they’re looking at not just what benefit package makes the most sense, but really what’s going to fit all of their needs. You’re seeing the technology, and that ecosystem-partnership piece, being just as important as the benefits conversation. If you have a subpar value prop with a platform, oftentimes the broker is not even going to recommend you or even look to quote you.

 

How does Ideon fit into Guardian’s digital strategy?

Guardian has the ability, through Ideon, to connect with multiple platforms that, for us to connect with each one of these individually, it’d be such a massive investment and endeavor. Working through Ideon allows us to get with more platforms faster.

As a carrier, there are only so many API connections you can build. So, the middleware allows us to access a greater number of platforms, which ultimately empowers the employer to be able to pick a broader set of platforms that are going to work well with Guardian. From our perspective, engaging with middleware really is about reaching more clients in the ecosystem they choose.

Just through the lens of BenAdmin and enrollment, the more connectivity you have, the better. There may be a reason that an employer chose a platform that Guardian is not integrated directly with. That’s fine. And that’s where the middleware allows us to really have that connectivity and expand our portfolio.

 

What digital solutions has Guardian implemented in the small group space?

I think an area that we’re really starting to push into—and push forward with Ideon—is really around real-time quoting capabilities. For us, if we think about the small group segment, a lot of brokers and group general agencies want to be empowered to self-quote, they want to be able to do it on their own time, on their platform.

And so really, utilizing that real-time quoting technology is an area that we are continuing to focus on. We feel like to create that shop through purchase through implemented-with-Guardian experience, where it’s a one-touch sales process, quoting technology is important. It can be a differentiator in the market.

 

Stay tuned for new episodes of Ideon Insights each month. Subscribe to our newsletter below to stay in-the-know about Ideon and receive our latest content directly to your inbox.

How BenAdmin Platforms Setup Carrier Connections in 5 Days

Posted on by Ideon

In the competitive world of benefits administration, setting up carrier connections can be an operational nightmare. What if you had a strategic guide to a better process?

This infographic is a gameboard for a BenAdmin’s operational life. Read it, play along, and compare two pathways side-by-side:

  • Navigate the EDI path: This industry standard typically takes an 8-12 week journey filled with building and testing files, errors, and constant communication with carriers.
  • Take a shortcut and win with API-powered connectivity: This alternate route reduces connection setup to around five days, optimizing your operational efficiency.

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