An easy-to-use provider directory.

1. Consumers’ Checkbook Submission to
RWJF & HHS Provider Network Challenge
DESCRIPTION OF BACKGROUND, NEED, TOOL, AND PLAN
Submitted by Consumers’ CHECKBOOK/Center for the Study of Services
1625 K Street, NW, Washington, DC 20006
800-213-7283 - aduff@cssresearch.org

2. Checkbook’s Relevant Experience
• Our nonprofit organization’s decades of experience producing websites and publications rating all kinds
of services, including doctors, hospitals, auto and homeowners insurers, etc.
• None of our publications/websites carry advertising; all are supported by consumers/organizations who pay to access the
information—good discipline to be valued and useful.
• Our research and user feedback as we have produced CHECKBOOK’s Guide to Health Plans for the past
35 years.
• For the 8 million employees and retirees covered by the 200+ plans in the Federal Employees Health Benefits Program, the largest
pre-ACA “exchange.”
• Dozens of agencies have subscribed to help their employees choose plans—HHS, Labor, IRS, Federal Reserve, etc.
• Our contracts with Exchanges
• With State of Illinois for our complete comparison tool for 2015 plans.
• With Minnesota to help in selecting plan quality measures.
• With Massachusetts, Nevada, and DC for all-plan provider directories.
• With Massachusetts and DC to provide actuarial OOP estimates.
• With CalChoice private exchange for our complete comparison tool.
• Our other experience such as for a period of years managing all of CMS’s surveys of Medicare
Advantage and Prescription Drug plan members.

3. Challenges Facing Consumers Using Health Plan Exchanges
• Emergence of health insurance exchanges
• Millions of people have new or expanded access to health care and choice of health insurance plans. Greater choice has created
new challenges for consumers considering a new plan:
1. Does the doctor I use (or would like to use) participate in the plan?
2. Are there sufficient high quality doctors available in the plan?
3. What is the true cost of my health care if I select this plan (insurance premiums are only a part of the answer) and what
benefits are available?
• Checkbook’s All-Plan Provider Directory tool answers questions #1 & #2, and when possible, we fully integrate the tool with our
existing Health Plan Comparison tool to answer question #3. These two tools are complementary and give users a comprehensive
evaluation of the key features of the plan choices available to them.
• Specific challenges in existing provider directory resources
• Consumers must tediously navigate the individual provider directories of the insurance carriers
• Each insurance carrier has a different User Interface (UI)
• Carrier directories often only reference network titles (rather than QHP/plan names); titles may not match Exchange-listed titles
• Many carrier directories contain incomplete, inaccurate, or duplicate records. Doctor names are inconsistent across directories
• Some carrier directories are slow or unresponsive
• Most directories carry little or no information that allows consumers to evaluate the quality of a particular doctor
• The Exchange does not use the directory information to present easily-used overall information on the quality and breadth of
each plan’s provider network.

4. Meeting Consumers’ Needs Through an All-plan Provider Directory
• Checkbook’s All-Plan Provider Directory tool consolidates doctor data from all carriers into an easy-to-
use tool. Checkbook has focused on design, usability, and content to deliver a “one-stop experience” to
efficiently prepare consumers to make an informed health plan selection.
• The directory includes truly unique doctor records (no duplicates) in an easy to use interface that clearly
shows which doctors are in which plans
Filter Options - Fast, dynamic search of doctors
• Carrier/Plan participation
• Location and Proximity
• Name
• Specialty
• Gender
• Languages Spoken
• Whether Doctors Are Accepting New Patients
• Whether Doctors Have Received Special Recognitions such as
• Bridges to Excellence recognition
• Consumers’ CHECKBOOK Top Doctor ratings by their peers
Additional Doctor Attribute Information – Listed on Detail Page
• Practice locations and Phone numbers
• Maps of the locations and the distance from the user
• Hospital affiliations
• Board certification
• Participation in Care Improvement Programs
• Medicare Programs: Physician Quality Reporting System,
Electronic Medical Records, Electronic Prescriptions, & Million
Hearts
• Crowd sourced patient reviews
• Reviews from tool users
• Reviews from existing independent review sources

5. Intuitive Design & Consumer Focused Features
• Checkbook’s tool goes beyond providing a directory of doctors and the insurance plans they accept. The
tool also provides user-focused information that is critical for consumers when selecting an insurance
plan.
• With Checkbook’s tool, users can:
• Select and view doctors side by side
• See counts of doctors in each available plan to evaluate network size – in aggregate or filtered by user criteria
• See descriptions of the 80+ specialties in the directory to help users find the specialty they need.
• Seamless integration into Checkbook’s Health Plan Cost Comparison tool*
• The cost comparison tool is an ideal entry point to the provider directory
• Users input demographics of themselves and their family members, and the tool gives them not just an all-plan provider
directory but the other elements (Actuarial estimate of Total Yearly Cost in good, average, and high expense years, plan quality
scores, and a full list of the benefits offered by each plan) the consumer needs to wisely select the health insurance plan that’s
best for them.
• A mechanism for reporting errors in reported doctor data. This feedback system improves the quality of doctor data for all users.
*In this Provider Network Challenge, Checkbook has not integrated the corresponding Health Plan Cost Comparison Tool as it falls outside of the scope of the contest. Checkbook has
built and integrated the two tools side by side in other iterations to give consumers a fully integrated offering; Checkbook’s recommended approach to exchanges.

6. Usability Highlights
• Checkbook’s tool is designed to efficiently deliver the information that users most commonly value in
picking doctors, while also allowing a deeper drill down for users looking for particular attributes.
Usability highlights include:
• Multi-platform support. Site is functional on desktop, tablet, and mobile platforms. No login required.
• Search results are updated dynamically as the user sets his/her filters
• Above-industry standard Service Level Agreement (SLA) to ensure content appears quickly
• Search results page displays the most important information on doctors without overwhelming the user with a cluttered display
• Search results display the doctor name, the practice address that is closest to the user (if the doctor has multiple addresses),
specialty(ies), carriers/plans the doctor participates with, and whether the doctor is accepting new patients for a particular plan
• To avoid long, cluttered lists in the search results, the tool displays the insurance carrier names and allows users expand/collapse
the full list of participating plans without needing the page to refresh
• After filtering by the user’s criteria, the tool orders search results by distance, with the nearest doctors at the top of the list. The
user can also choose to sort results by doctor name.

7. Delivery of Doctor Quality Data
• Because the quality of a doctor plays such an important role in the medical care patients receive,
Checkbook’s tool delivers not only which doctors are available in each plan, but also numerous quality-
oriented data points that allow users to find plans that have high quality providers in their networks.
These data points include:
• Bridges to Excellence Recognitions – indicates doctors who are recognized as performing above average in specific medical fields
• Consumers’ Checkbook Top Doctors – indicates doctors who are highly rated by peer physicians
• Care Improvement Programs – indicates doctors who participate in Medicare’s Physician Quality Reporting System, Electronic
Health Care Records, Electronic Prescribing, and Million Hearts programs
• Board Certification – indicates doctors who are board certified in their specialty according to the American Board of Medical
Specialties
• Crowd Sourced Consumer Reviews – provides quantitative and qualitative reviews of doctor’s care from the patient perspective
• The tool incorporates reviews from independent sources (Consumers’ Checkbook)
• Tool also allows users to rate and provide comments on doctors directly through the tool
• Health Plan Quality Ratings – indicates plan quality based on metrics including % of doctors with: Bridges to Excellence recognition,
high frequency of peer physician recommendation, and member satisfaction

8. Sources, Accuracy, and Update Frequency of Data
• Data accuracy is a top concern of any health plan provider directory. Checkbook’s data processing
utilizes multiple sources of doctor data to validate, append new attributes, and fill in gaps before
displaying content to end users.
• Checkbook derives its doctor-health plan participation data from data feeds that are supplied directly by
the health insurance carriers
• Data is updated on a monthly basis. The tool is designed for a future state that allows even more frequent updating.
• Doctor records are matched between carrier data feeds and external data sources. Checkbook uses the
NPI number as the primary matching key across data sources, but also employs sophisticated alternate
matching processes developed for high-stakes doctor matching purpose. Alternate matching processes
are used when the NPI number is unavailable or inaccurate (a frequent occurrence in carrier data
feeds).
• External data sources include: NPI directory, CMS’s Physician Compare, Health Care Incentive’s Bridges to Excellence, and others
• Because the carrier data feeds play the most critical role in the accuracy of the plan participation
content, Checkbook prepares and delivers reports back to carriers each time they provide new data.
These reports help carriers identify and correct potential problems in the data, which in turn improves
the quality of subsequent data files.

9. Real World Implementation
• Checkbook has built provider directory tools for public and private exchanges across the country. We have
worked with a variety of states, organizations, and health plans and have proven that this work is not only
feasible, but affordable.
• The tools Checkbook has built have earned critical acclaim and share many of the features of the provider
directory tool we are submitting to the HHS/RWJF contest.
• DC Health Link Public Exchange Provider Directory – Spring 2015
• CaliforniaCHOICE Private Exchange Provider Directory – January 2014
• Nevada Health Link Public Exchange Provider Directory – October 2013
• Illinois Public Exchange Complete Plan Comparison Tool – January 2014
• Checkbook’s Guide to Health Plans for Federal Employees Online Plan Comparison Tool – Online since 2002 (in print since 1980)
• Business Model
• State exchanges, private exchanges, foundations, or other exchange players contract with Checkbook to provide our hosted tool for their
specific exchanges. CSS charges an annual license fee to these clients. The fee amount depends on a number of things including number of
carriers, networks, & plans on the exchange; frequency of data updates; type of integration into the exchange website; number of users; etc.
• Typically the annual fee for our provider directory for an exchange is between $150,000 and $300,000.
• In our model, the tool is always free to users; and we don’t accept advertising fees or commissions (to eliminate any potential or perceived
financial bias when evaluating and presenting plan/doctor results).
• The tool is affordable as evidenced by existing implementations - Checkbook’s provider directory and plan comparison tools are built to scale
quickly to other exchange marketplaces.

10. Well Informed Consumers Make Better Health Care Choices
Checkbook, a nonprofit organization whose mission is to inform and educate consumers,is
proud to offer our all-plan provider directory as a component of Checkbook's Health Plan
Comparison Tool that makes sense of an otherwise confusing and overwhelming landscape of
health plan-doctor participation information. We look forward to working with HHS and the
Robert Wood Johnson Foundation to help consumers across the country make well informed
health care choices.