Bad Data Now Illegal in CA


There’s a new law in California that mandates that health plans maintain accurate provider directories. It’s a serious piece of legislation; health plans are even empowered to withhold reimbursements from physicians and other healthcare providers if they don’t cooperate in providing current data to the health plans.

Why has it come to this?  The reasons help illustrate some of the challenges in maintaining commercial databases today.

You would think that health plans would know a lot about the physicians in their plans, at the minimum where they are located because they are regularly sending checks out to them.  But as those of us who have dealt with physician databases well know, it just isn’t that easy.

For starters, many physicians like to receive checks at a location other than their offices. Post office boxes are still common. Some physicians have management companies located in separate offices collect funds for them. And of course, payments now are increasingly electronic – account to account with no address needed. All of this makes it hard to simply using billing information as the basis for a plan directory.

Physicians are also increasingly part of group practices. And these group practices often have multiple office locations. Physicians in these practices move around from location to location, making it difficult for physicians to provide a single physical address. The group practices themselves are often radically decentralized, so there really is no main office even for the group. Some groups cross county and state lines. Some groups have separate administrative offices. And then there are the doctors who work out of hospitals … this is just the tip of the iceberg, but you get the idea.

But the biggest problem of all is the industry’s failing. Physicians see a plan directory as one more administrative burden; health plans see an annoying cost center. The reality is that these plan directories are a prime marketing tool for both groups. Different surveys confirm that some stunning percentage of patients select their physician from these directories. Health plans market themselves on the quality and breadth of their networks. The first question of anyone contemplating a switch to a new plan is, “is my doctor in your network?”

By not understanding and leveraging the fact that health plan directories are a primary discovery tool and a great marketing vehicle, we end up in the sorry situation where government has to legislate accuracy when instead all those involved should be insisting on it themselves.

The best databases are those where the listed individuals or organizations see real benefit in participation. If this is true in your case, promote it like crazy. It’s too big an opportunity to miss.