Provider Data Dorks

Starting in 2028, every health plan will have to confirm that every doctor in its directory is actually there, every ninety days. Nick Bernold thinks the goal is right and the mechanics are close to impossible. Ten to fifteen payers calling the same practice, reading sixty names down the phone to an office that's booked from opening to closing. His words for what happens next: the practices hang up. He's already testing the workaro...

Eric Galvin has run health plans as both CFO and CEO. At one of them, the directory data was bad enough that regulators raised concerns about whether consumers could actually find care. He says so plainly here, then describes what he found when he went looking: a scary place, with all kinds of scary reasons the data is the way it is, most of them things the industry did to itself.

Eric spent nine years at ConnectiCare as CFO and the...

Every health-tech company promises AI will make you healthier. Dr. Ankoor Shah says that's not what the technology is actually being built to do. A pediatrician who co-led Washington DC's COVID-19 response and now serves as VP of Clinical Excellence at Included Health, Shah delivers two on-record hot takes: that healthcare technology has historically widened disparities rather than closed them, and that today's AI is funded to opti...

Most health plans manage the invisible backbone of healthcare, provider data, across disconnected systems, spreadsheets, and vendors that don't talk to each other. One bad record cascades downstream into claims, payments, and patients who can't find a doctor. So why do so many plans still try to build their own fix?

Sam Deshpande spent 17 years at Capital One in risk and credit, then ran risk, technology, and information at Humana a...

Finding an in-network doctor shouldn't take twenty phone calls. But provider directories (the invisible backbone of healthcare) are wrong so often that the best payers in the country top out at 70% accuracy, and the worst sit at 30%.

Most people assume that gap is a mystery. Ron Urwongse proved it's measurable.

Ron is the co-founder of Defacto Health and former innovation and strategy lead at CAQH. When CMS mandated that insurers pub...

Steve Klasko was a DJ named Little Stevie Kent who got into medical school partly because an admissions officer recognized his voice from the radio. He then spent 40 years proving that listening (really listening) separates transformational leaders from the ones who just manage decline.

As CEO of Jefferson Health, he took a $1.5 billion system to $10 billion in nine years, fought the FTC, and made enemies in every insurance boardroo...

Provider data has been called the invisible backbone of healthcare. It drives directories, network adequacy, credentialing, claims… basically everything. And in most organizations, it's still managed through spreadsheets, siloed systems, and a stack of vendors that don't talk to each other. So why hasn't the industry fixed it?

Tyler Ford has spent his career at the center of that question, from the Advisory Board to UnitedHea...