Provider-network data is revolutionizing health & benefits technology 

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. 

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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.

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

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.

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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.