@wcsanders @bjdickmayhew found out that the community health center in Concrete WA is labeled multiple ways on WA exchange provider search
— rebeccastob (@rebeccastob) November 2, 2016
Rebecca is an actuary and a health policy nerd who has been extremely helpful to me during many Twitter conversations. She is identifying a very legitimate problem of directories. who owns the source of truth?
Right now, providers own their data. They decide what they call their practice, they decide what address format they submit. They decide if they are taking new patients, they decide what their hours are. The providers then supply that data to the different carriers that they contract with. They also supply that data to a number of third party web display vendors. The downstream entitities can correct for obvious errors like a four digit zip code or a street address that was fat fingered and placed the office location in the middle of an Army Corps of Engineers’ lake. But the insurers don’t own the data.
Some regions will have a common sheet for the carrier to fill out, most regions have a variety of sheets or data entry screens for the carrier to complete. This is where there are significant problems.
A low level staffer could be told to complete the office profile for eight insurers by the end of the week. The office thinks they are doing well as they are engaged in a timely data refresh and revalidation cycle. This is an improvement over letting the data sit for three to ten years and seeing half the original practice working on their golf swing in Florida during their well earned retirement. But it is flawed.
123 Main Street is a legitimate address.
Suite 500, Big City Medical Commons is the same location with a wildly different descriptor.
Main and Elm Streets, NE Corner is also the same location.
123 North Main Street is also the same location.
No one owns the data validation and data consolidation step. These are all valid addresses/locations. Some are in a more preferred format than others but the postal service will deliver mail to all of these locations especially if there is a valid and relevant zip code attached.
AHIP, the insurance industry group/lobby, is playing around with a single source of truth portal in half a dozen states so that providers enter their data in a single location, that single location curates and validates the data, and then the single location serves it out to the relevant insurance companies. This would be a significant improvement. The Center for Medicare and Medicaid Services (CMS) is cracking down hard on bad directories and more importantly, out of date directories. There is effort to get better data out there for people to use. As we see a proliferation of high deductible plans along with narrow networks tied to plan designs that do not give out of network benefits, the data has to be better.
We’re not there yet.
Most community health centers received special funds for “Outreach and Enrollment” activities, and the people paid for by those funds must be trained to help people navigate the system. (There’s been some talk of making those dollars a permanent part of the base award for community health centers.) That is: it’s a good bet that there are staff AT the CHC who can help a person navigate those issues. And, for that matter, they can help you get enrolled even if you’re not a patient at that health center and don’t want to be.
@narya: Yep, the FQHC, RHC and general community clinics are very valuable resources. I was at a meeting yesterday at an FQHC and there was a navigator in the waiting room helping people figure out next years’ insurance as they waited for their appointment.
Addresses are actually easier than names. Data entry and validation is something everybody thinks they instinctively understand, but that’s only because they’ve never really given it any thought. Add in the fact that when a system tries to force the user to change the way they look at data, their interest in getting it right drops. If you don’t know the difference between a matronym and a last name (or middle name), users aren’t going to trust your system, and aren’t going to care about entering good data.
Add to that stupid programmers who think that stripping our punctuation is the proper way to guard against sql injection attacks and you make it impossible for people to properly enter their name or address. And it’s amazing how many systems choke on unicode even in this day and age. No excuse.
Know what really makes you want to rip your hair out? When you’ve spent months working on a data entry library that will handle honorifics and accents and unicode and long names and one of your downstream vendors tells you they only accept 15 chars of of straight ASCII.
now you’re speaking my language! i happen to write/maintain address validation software for a living.
USPS will do its best to get the mail somewhere. but they offer you postage discounts if you clean up your mailing list by processing it with software that has been certified to meet the USPS’s addressing guidelines – it makes their job easier.
unfortunately, a single physical address can have multiple, equally-valid, postal addresses. businesses (landlords, especially) want it this way because it lets them brand their buildings.
725 5th Ave
New York, NY 10022
New York, NY 10022
are the same place, and are both valid addresses : they’re both in the reference data the USPS provides every month. either one matches in any USPS-certified software. and there are thousands of addresses like this.
FWIW, the USPS reference data has no punctuation, is in all-caps, and is all plain ASCII. if you’re using that to correct/validate addresses, you have to strip it down. (other countries are a different story)
My providers keep getting bought out of their private practices into one of two giant hospital systems. The pulmonologist I saw yesterday was a classic example. They closed his little local office that had three or four employees who were excellent at their jobs and moved him into a giant new medical building much farther away. He is in a branch hub with 15 other doctors and 23 exam rooms.
Nobody from the central receptionist to the nurse that had to have help from my caregiver to take my blood pressure with the machine to the doctor could work the computer system. The visit took three times as long as it usually does because of this.
I needed a new CPAP mask. Before I just called the company, who called the doctor and mailed it to me in four or five days. Now the doctor has a whole other set of hoops to jump through and it’ll take three to four weeks. I have regular Medicare and the gold-plated Plan F supplemental so there’s no insurance issues, it’s just a whole other layer of inefficient bureaucracy inserted.
So frustrating. It seems like there are massive monopolies being formed that will cost a lot more and deliver a lot less.
@cleek: Yeah, my last graf was about that. All decent folk can dois try to collect good data and only dumb it down for people that don’t take real data.
@Mike J, @cleek:
I used to do programming for address entry/verification, but not on a massive scale. But quite enough to see the gnarly problems that you quickly run into. Brr!
I had (past tense, I hope) a rare but nagging address problem with my bank. Occasionally on line some order form will want me to “verify the address” for my credit card. I put in my address, 123 Threadkill Lane, and a couple of times it came back as wrong/unverified. I went to my account page on the bank website and saw that they had:
When I tried to edit it, a little box came up with the erroneously formatted address, said it’s the “USPS-approved version” or something, asked me if I wanted to accept it but wouldn’t let me change it. I ended up calling the bank, I think, and supposedly a human changed it. I haven’t had the problem in a while, but the situation comes up only rarely, so I don’t know if it has really been fixed.
I thought it was especially weird because it’s a big, national bank that should be all over this stuff.
ETA: Virtually all the junk mail, bills, etc., I get, including stuff from USPS, comes through to “123 Threadkill Lane/Apt. 202.” So it’s clear that that is the “official” address.
The town where I live was established to be like a Spanish village and it’s in the city chartered whatever it’s called that all street names must be Spanish in the Spanish style. So it’s Avenida Vista and Calle de la Mer, with the street name second. USPS is fine with it, but when we talk to a call center in another state or country we run into someone who insists that they have to have something to put in the box after the street name. So we get mail to Avenida Vista Avenue, which is annoying.