Helping Aligned Marketplace Build a Quality and Reliable Provider Network
Finding a doctor is hard, as you may know if you've tried to book an appointment with a doctor through your insurance company's website. What's worse? On average, you'll need to call four different doctors just to find one who can actually see you.
Industry Challenge
Finding a doctor is hard, as you may know if you've tried to book an appointment with a doctor through your insurance company's website. What's worse? On average, you'll need to call four different doctors just to find one who can actually see you.
Aligned Marketplace
Aligned Marketplace is tackling this problem within primary care by connecting employers to a national network of advanced primary care groups that are not only in-network and accepting new patients, but providing personalized and comprehensive care that prioritizes outcomes and experience.
Obstacles Faced by Aligned
When Aligned Marketplace started building their network, they quickly faced the typical challenges of inaccurate in-network status, location, and contact information. But the most frustratingly misreported field was 'accepting new patients'.
Aligned attempted multiple routes to solve this challenge, from reviewing provider websites (often outdated) to checking provider insurance portals (often wrong). There were hopes of using a claims based approach, but given the lag, and lack of detail and comprehensiveness, claims wouldn't be accurate or timely enough for their members. It felt like short of calling every clinic for availability, there wasn't a scalable way to solve this.
Candor's Solution
Beyond the basics of getting accurate and up-to-date provider data, Aligned needed a platform to manage their provider network actively and stay alerted to changes (like when a doctor starts or stops accepting certain insurance, opens a new practice, moves away, or retires).
Using Candor's live provider tracking revealed significant differences in 'accepting new patients' compared to what was reported online. Shockingly, even if a provider is listed online as "Accepting New Patients" through their website or payer portals, it is true only 25% of the time.
Results
With this insight and the Candor platform, Aligned is now efficiently guiding their members to the right primary care providers, saving hundreds of hours of ongoing effort and saving their members the time and headache of the guess-and-check through clunky insurance portals or outdated websites.
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