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Humana taps Veda to improve accuracy of provider directories


Photo: Reza Estakhrian/Getty Images

Humana has partnered with health technology company Veda to improve the accuracy of its provider information and ensure that seniors have real-time details about in-network providers.

The effort is meant to confront challenges in ensuring the accuracy of provider directories. Maintaining up-to-date provider directories, including accurate phone numbers, addresses and panel status of in-network practitioners, is critical to helping seniors make informed choices about their healthcare, Humana said.

WHAT’S THE IMPACT

The company said that it historically has made millions of calls annually to confirm provider data, but there have still been ongoing inconsistencies and inaccuracies in the directories, which can make it harder to find a provider and lead to administrative burden for seniors, providers and health plans.

Veda will use its automation technology to analyze, verify and standardize Humana’s data to ensure it’s accurate and comprehensive, along with real-time scoring of data quality. Veda maintained that its platform achieves high data accuracy, ensuring quality across networks as measured by the Center for Medicare and Medicaid Services. 

Veda’s automation will allow Humana to devote more time and resources to enhance the patient experience, the insurer said.

Robbie Tindall, vice president, Provider Process Network Operations at Humana, said the company wants to be a partner with CMS and policymakers in improving data accuracy.

“This collaboration with Veda will enhance not only the experience for our members, but also our provider community,” he said.

Humana said that in addition to working with Veda, it will continue to apply best practices in ensuring that provider directories are accurate and up-to-date. The organization highlighted efforts to create a National Directory of Healthcare Providers and Services, and said it has provided feedback to CMS about how such a national effort can increase patient satisfaction.

THE LARGER TREND

Despite logging $26.6 billion in revenue for the fourth quarter of 2023, Humana posted a $541 million overall loss, pinning much of the blame on a higher-than-anticipated increase in Medicare Advantage costs.

Officials said the cost increases were largely driven by climbing inpatient costs and more spending on outpatient surgeries and supplemental benefits. In a prepared statement on its financial performance, Humana said it was “disappointed with the impact of the late and unexpected development of higher trends on our 2023 results and 2024 outlook.”

ON THE RECORD

“Accurate provider data is a key component of efficient health plan operations, care delivery, interoperability, and ultimately patient satisfaction,” said Veda co-founder and CEO Meghan Gaffney. “By addressing the challenges that members may face with finding in-network care providers, Humana is ensuring their members have access to the timely, high-quality care they deserve.”
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.



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