Insurers Ready to Meet Federal Exchange Transparency Requirement

But transparency advocates say 2016 is not soon enough and that this information needs to be available now.

Several insurers in Oregon say they are on board with an upcoming federal requirement that aims to create an easier and more transparent process for finding your doctor on the federal exchange. 

But these insurers also say they don’t yet know what resources it will take, and that they want to ensure there is a balance between transparency and protecting privacy. 

By 2016, insurers in the federal health exchange will have to “publish an up-to-date, accurate, and complete provider directory, including information on which providers are accepting new patients, in a manner that is easily accessible to plan enrollees, prospective enrollees, the state, the Marketplace, HHS, and OPM,” said Aaron Albright, director of Media Relations Group Centers for Medicare and Medicaid Services

The rule also requires insurers to make access to information easy for the general public, not just members. The federal government is also seeking input on the best way to make the data available in machine readable formats. Insurers say they are unsure what it will take to make the latter part of the rule happen. 

“Our online provider directory already meets the majority of the requirements outlined in the rule change, including being searchable by the public without the need for an account or password,” said Kathy Jost, marketing and communication manager for PacificSource Health Plans. “As final rules have not yet been communicated around this issue, and there are still some unknowns, like how “standard machine readable formats” will be defined, we can’t say for sure yet whether financial or other resources will be needed to meet all the requirements.”

And health insurer advocates in Washington D.C. are also concerned about the logistics of making the data available in machine readable formats. 

“The concern is that there’s not consistency in the sort of standards across the board in how that information should be presented,” said Clare Krusing, communications director for American Health Insurance Plans, a national insurance trade organization that represents some companies in Oregon. AHIP has submitted comments of its concerns to the Department of Health and Human Services. “That’s where our focus is. What is the best way that we can show this information and give it to consumers.”

“In reality this is a critical component of healthcare reform and unless it happens, you’re just going to have a bad new system instead of the bad old system,” said Fred Trotter, healthcare data journalist and founder of CareSet Systems. Trotter is advocating for the federal government to move the requirement up to this year. He said as soon as data open it will be easy for companies across the country to make it readily available and easy to access. 

“If you don’t have open data it’s an impossible problem,” he added. 

Already on it 

Several Oregon insurers said they already meet or are in the process of meeting the new requirements. 

“Cambia strongly believes in giving consumers the information they need to make more informed healthcare decisions. One example of our commitment to transparency is HealthSparq, a Cambia company that works with health insurers to provide cost and quality information to members,” said Jared Ishkanian, who handles strategic communications. “This only amplifies the need for healthcare transparency. HealthSparq will continue to work with health plans nationwide to offer their members the cost and quality information they need to make informed healthcare decisions moving forward.” 

Officials with Lifewise Health Plan of Oregon and Providence Health Plan both said their websites already provide information to the general public on which doctors are in network and accepting new patients. 

“We will comply with any new requirements the federal government may finalize for provider directories. We don’t expect those requirements to include any significant changes to our current practice,” said Olivia Ramos, senior public affairs coordinator for Providence Health & Services. 

No Guarantee 

Insurance companies encourage patients to check with their doctors to make sure they are in network because it is often fluid. But Trotter said sometimes even the doctors are unsure if they are in network for the various plans. 

Krusing said both sides, providers and insurers, need to do a better job of ensuring information is accurate and up to date. 

“There’s a lot of focus now on working with providers to make sure there is more timely and frequent information on both sides,” she said. 

Dawn Bonder, CEO of Health Republic Insurance, said part of the problem is that the networks are often changing. 

“We struggle with trying to get really up to date accurate information on provider and provider networks,” she said, adding the company does not have its own contracts but has a rental agreement with Providence. “We struggle with trying to get really up to date accurate information on provider and provider networks.”  

Trotter said patient access to information about provider networks should already be a given on the federal health exchange so officials can dig into real problems and make the healthcare system work better on the whole.

Shelby can be reached at [email protected].

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