The Open Group Provider Data Directory
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This collaboration site is an open site that will be used to collect inputs from both members of the Open Group Healthcare Forum, and non-members.

The Open Group Healthcare Forum is undertaking a new program of work focused on payer’s collection of provider data in directories that can be used to the benefit of payers and providers and members.  The purpose and aim of this “Healthcare Provider Data Directory” program of work is described below.  

Healthcare provider directory data consists of contracts, credentials and demographics.  Healthcare payers contract with providers to deliver services to their members.  Payers maintain provider directory data to direct their members to qualified providers, enable their members to estimate treatment costs, pay claims and other forms of provider compensation, and work with providers to improve healthcare access, quality and affordability.  Providers use directory information from payers to make in-network patient referrals, and to help ensure they receive appropriate referrals and correct compensation. 

Providers and payers must therefore exchange accurate, timely and complete directory information.  Unfortunately, this process is highly complex and inefficient.  Providers must often give the same information to multiple payers, who struggle to keep their information accurate as they serve members, pay claims, and manage care.    This problem is intensifying as healthcare reform demands new high-performing networks, in which providers participate in addition to traditional networks.

The Open Group Healthcare Forum will publish a White Paper that explores these challenges and proposes an approach to secure and efficient exchange of provider directory data information, so that payers and providers may better focus on their core healthcare missions.  The White Paper will first describe provider directory data stakeholders and their interactions, relevant standards, and emerging solutions.  It will then explore the challenges and opportunities of the status quo.  Finally, the White Paper will set forth a vision for provider directory data management, and propose specific steps for its realization.

Provider directory data management improvements are upstream of most healthcare activity, therefore their benefits are potentially quite broad.  Improvements to provider directories could benefit access to care, since they could help people find convenient and affordable physicians. They could also benefit cost of care, since they could reduce administrative overhead and make the care marketplace more efficient through dissemination of accurate information.  Furthermore, improvements could benefit patient and provider experience by reducing the uncertainty and frustration caused by inaccurate information about the availability of medical care.

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