- Quest Analytics announced Monday it has acquired BetterDoctor for an undisclosed sum.
- The deal — which aims to help solve provider network accuracy issues — combines Quest Analytic’s network decision support tools with BetterDoctor’s primary source-verified provider data management platform. The combined company will operate under the Quest Analytics brand.
- John Weis, co-founder of Quest Analytics, said in a statement the company will be providing data to 300 health plan customers. The deal will be financed by Vestar Capital Partners, which acquired Quest Analytics in August, and Health Catalyst Capital, which first invested in BetterDoctor in April 2017.
Network accuracy is a big problem for patients and providers. Incorrect information, such as not knowing a doctor doesn't accept Medicare patients or has moved his or her office, can complicate the process of getting care and leave patients with surprise medical bills if they unwittingly receive care from a provider who is out-of-network.
In a recent American Medical Association and LexisNexis Risk Solutions survey, more than half of physicians reported seeing patients each month with coverage issues linked to incorrect information about in-network doctors.
Provider data inaccuracy is costly for payers as well. According to a recent CAQH report, commercial insurers spend $2.1 billion annually to maintain provider databases, three-fourths of which could be avoided by integrating with an external data source. And plans that fail to keep directories up-to-date face stiff fines — up to $25,000 per error per physician and up to $100 per physician for errors in plans sold on HealthCare.gov.
The report offered a roadmap to achieving greater provider directory accuracy, including adopting a common basic data set and quality standards.
The problem is not limited to private payers. A recent CMS report found 52% of Medicare Advantage online provider directories were inaccurate. An earlier CMS review showed a 45% inaccuracy rate. The agency has requested more oversight of MA directories and suggested MA plans self-audit their directory data to reduce the problem.
The Quest Analytics and BetterDoctor combo could have potential, but only if the provider data is completely accurate, current and available.
The company isn’t the only one jockeying for a position in the network directory space. The AMA is working with LexisNexis on a effort that centralizes provider data to meet state and federal directory mandates. The product, called VerifyHCP, allows physician practices to update information for all participating health plans in one place.
Earlier this year, Humana, MultiPlan, UnitedHealth Group’s Optum, UnitedHealthcare and Quest Diagnostics announced a blockchain-enabled initiative to improve data quality and reduce time and costs associated with changes to provider information.