1 billion provider office visits. 293 million health plan enrollments. 4 billion drug prescriptions. 33 billion claims processing transactions. These are just some of the interactions occurring across the healthcare system every year that require accurate data about healthcare providers.
And yet access to that data is anything but straightforward—it’s fragmented, out-of-date, inaccurate, and not in a form that is readily available at the point-of-transaction, even in the data systems of the very hospitals and clinics where these providers are employed and work. In fact, studies have shown that over 50% of provider listings in online directories can be inaccurate at any given time. There have even been high-profile lawsuits against health insurance companies for misleading consumers with inaccurate provider directory information.
Why is this seemingly “simple” information so hard to maintain and access? Part of it is that different stakeholders have responsibility for different segments of the data, and they don’t interoperate. For instance, licensure data are maintained at the state level, while practice credentials and privileges are maintained by individual payor and provider organizations, and contact information is maintained by hospital marketing teams. Another part of it is the rapid pace at which the data changes—nearly 30% of provider information changes every year. And so far, we’ve just been talking about “name, rank, and serial number type” of information—good luck finding any information about what kinds of patients a provider sees, what services they provide, when they have appointment availability, or the quality of outcomes that patients have achieved with them.
All this means that every time we get a referral, every time a claim is submitted, every time we enroll in a new health plan, it’s quite likely that some portion of the data we’re using to inform those interactions is incorrect. At best, that leads to inefficiency, waste, and opacity in the healthcare system. At worst, you may end up getting inappropriate care, costing you and the system unnecessary spend, and utilizing precious capacity that could have been otherwise applied to higher value purposes.
The Quest to Solve the Provider Data Problem
When I first met Nate Maslak and Nate Fox, the co-founders of Ribbon Health, they, like many, had their own personal stories to share about the perils of not being able to find the right doctor. Their stories resonated for me as someone who has had similar experiences as a patient, and also from my experience as an operator at a series of companies that relied on accurate provider information as part of their core operations.
What the market has needed is a nationwide utility that serves all stakeholders with accurate data to effectively route patients to providers and health plans in the context of their daily operations. And that is what Ribbon Health has built: an API platform for real-time access to a nationwide provider and health plan directory, covering demographic, network, cost, quality, and other actionable information. As I learned more about the nationwide, networked-approach to provider data management that Ribbon has implemented in its product and business model, and heard the delight of customers who had long been searching for “a better way” to solve this problem, it became clear that Ribbon was uniquely poised to lead the market in addressing this pervasive challenge.
In the same way that the API economy has transformed how business is conducted in areas like e-commerce and financial services, it is finally healthcare’s turn to up its game—with APIs that help its players tighten up their operations and focus on their core competencies, instead of spending precious resources reinventing the wheel across thousands of walled gardens. And as the healthcare industry finally starts to execute on the promise of interoperability as laid out by HIPAA, HITECH, and the 21st Century Cures Act, that API form factor will increasingly be valuable to the myriad apps and services that will want to embed the core building block of provider or health plan search into their own workflows.
That’s just part of the reason I’m so excited about leading the Series A investment into Ribbon Health. Interacting with the healthcare system is challenging enough; we (patients, providers, and administrators) deserve to be able to take for granted that those interactions will be informed by reliable information. Ribbon’s platform does just that, in keeping with its core mission to “simplify healthcare”.