Here’s my most recent contribution to the effort around deploying data interoperability standards for use with healthcare provider network directories. The schema proposed for use by QHP (Qualified Health Plans) on health insurance marketplaces can be found on GitHub: https://github.com/CMSgov/QHP-provider-formulary-APIs. Designing an improved model for the provider directory and plan coverage standards required analysis of:
- CMS’s templates for gathering QHP data on: Network Adequacy and Plans and Benefits
- CMS’s public use files of historical data on: Networks, Plan Attributes, Benefits and Cost Sharing
- Collected input from the industry workgroup, consisting of payers, payer-provider intermediaries, providers and consumer applications
The data model now looks like this:
Background info on this topic can be found in the related DDOD article.