AI and APIs Team Up to Solve Provider Directory Problem for Patients

Ribbon Health AI tech powers Health Karma patient-friendly provider navigation and telehealth service.

At a time when the digitization of healthcare is turning parts of it into commodities, but out-of-date provider directories continue to thwart successful patient-provider connections, some providers are stacking technologies like double-decker sandwiches to improve patient experience and navigation, aiming to reduce visits to emergency rooms and urgent care centers.

One such example is the recent collaboration of patient navigation and telehealth service Health Karma with the AI-powered application program interfaces (API) created by Ribbon Health. Health Karma says its new service offers patients more accurate and reliable provider directories, coupled with navigation that zeroes in on the precise provider specialties that patients seek.

Ribbon Health's technology tackles the problem of provider directories differently than traditional approaches, which often ends up laced with errors or plagued by being out of date.

"Ribbon is aggregating over 1,000 different data sources on providers at any given time," says Nate Maslak, chief executive officer and company founder of Ribbon Health. "We have data partnerships and licenses, and scrape the open web, open government data sets, whatever is out there, to make sure that hits our system."

Nate Maslak is the CEO and company founder of Ribbon Health. Photo courtesy of Ribbon Health.

The gathered data is filled with duplicates and contradictory information. "We see over 50 phone numbers per doctor," Maslak says. "And that's just phone numbers." Physical addresses and insurance plans accepted can also return their own set of contradictory results.

Ribbon Health then applies machine learning to these data sets to predict which information about each provider is currently accurate. "If 800 sources say that Dr. Smith is at 123 Main Street, and 200 sources say she's at 400 University, what's the probability that either or both of those locations are right at this moment in time?" Maslak says. "Our algorithms assign a confidence score to that, and that's what we deliver to our customers."

Ribbon Health customers, such as Health Karma, receive their own copy of Ribbon Health data through Ribbon Health's API, and can modify or edit that data as they see fit, Maslak says.

Other Ribbon Health customers include care navigators and insurance brokers. "There are many referral management workflows that we power and sit behind the scenes of," Maslak says. "Our goal is to make it possible to integrate with anybody everywhere."

In many cases, Ribbon Health automation has replaced physical binders of outdated referral information at healthcare providers that required vast human patient navigator resources to utilize and maintain, leading to too many unnecessary patient visits to emergency departments and urgent care, Maslak says.

For digital-first Health Karma, the Ribbon Health data powers a patient experience aimed at simplifying healthcare navigation, not only for the uninsured, but for patients who find the websites of typical small employer-provided or individual insurance plans to be too complex, error-riddled, or out of date to be useful, says Michael Swartz, president and co-founder of Health Karma.

In addition, Health Karma provides low-cost monthly telehealth and behavioral health services, Swartz says. "For a lot of people, the most value lies in our virtual primary care and behavioral health programs," he says. Discount prescription medications are also available through the Health Karma site.

Michael Swartz is the president and co-founder of Health Karma. Photo courtesy of Health Karma.

In the future, Health Karma plans to offer online booking of appointments, but for now, its provider directory directs consumers to the provider's phone number.

If a consumer visiting Health Karma already has insurance and registers with the site, the site can make sure the consumer goes to an in-network doctor, or they can use the Health Karma virtual primary care until they need to go to that in-network doctor, he says.

In addition, Health Karma is arranging for small employers to enroll their employees into a personalized Health Karma navigation service, using Health Karma's more up-to-date provider directory, Swartz adds.

"We realized most people just do not have the knowledge to be a healthcare consumer," Swartz says. "That lack of knowledge was making people hesitate to interact with our marketplace, or healthcare as a whole. So, two and a half years ago, we took a step back and said we need to bridge the gap of confidence."

One way Health Karma differentiates its virtual offerings from others is by letting patients choose and retain their providers, creating ongoing patient-provider relationships, instead of being helped by different providers from visit to visit, Swartz says.

And unlike pure-play telehealth offerings, Health Karma can navigate consumers to brick-and-mortar physician and therapist locations, based on the insurance they carry, he adds.

"We don't offer insurance plans," he says. "We're able to integrate into over 2,000 different insurance plans. We do work with a lot of brokers, and there is potential going down that road of making it easy for you to decide if plan A or plan B is better for you, potentially."

Swartz likens Health Karma to some of easy-to-use fintech startups, such as Nerd Wallet, which helps financial consumers select from a mix of credit cards, investing, insurance, loans, and banking, among other things.

But to build that service, Health Karma had to have "top of the line" data about insurers, which is what Ribbon Health provides.

To further pinpoint the expertise of providers, Ribbon Health acquired claims data from multiple private proprietary sources, the company says. This data lets Health Karma visitors select providers based on a sophisticated set of search terms.

"Let's say you want a mental health therapist that focuses on ADHD, [and] has experience treating female adolescents 13 to 21 years old," Swartz says.

Using such criteria, consumers can sift through hundreds of potential providers to reach a handful that precisely meet their needs, he says.

"That's what we're trying to do, not only with mental health, but with all different types of search," Swartz says.

The Health Karma site also draws upon provider ratings generated by Healthgrades.com, although the Ribbon Health approach gives consumers much better search results than they would get by just visiting Healthgrades, he adds.