Perspective_

Provider data has become core infrastructure for healthcare. Everything — from finding care, to planning enrollment, network validation, and fraud prevention — depends on it, and provider directories are the centralized source of this data. In recent years, separate directories have proliferated across dozens of disconnected state, health network, and program systems, forcing providers to update the same information repeatedly and creating inconsistencies that ultimately lead to billions of dollars in waste and disincentivized participation.

At the same time, that fragmented data has become a blocker for patient-centered experiences. When provider information is incomplete, outdated, or inconsistent, patients encounter inaccurate network listings that can lead to unnecessary fees and delays in care. For payers and administrators, the same fragmentation drives manual reconciliation and introduces avoidable risk. To function as true infrastructure, provider data must be validated at scale and structured to integrate seamlessly across systems.

Recognizing this, the Centers for Medicare and Medicaid Services (CMS) is reframing the role of provider directories, transforming them from static artifacts to shared national infrastructure. They have signaled a clear call for industry participation in building a system that is trusted and broadly adopted.

March 31 is a big day for the Health Tech Ecosystem, as CMS moves to put real national infrastructure in place with the launch of an initial national provider directory (NPD). This is a foundation to unify how provider directory data is collected, maintained, and accessed across the healthcare system. The opportunity now is to build on that foundation quickly, focus on adoption, and scale what works so providers, patients, and payers feel the impact, quickly. That means ensuring the system is usable by all stakeholders, and that state-sponsored healthcare systems, health insurance providers, and patients can all rely on it. Because, to have a single source of truth, you need a critical mass of participants willing to provide and update their data.

Adoption of a directory across the immense expanse of our healthcare system will only scale if we make it genuinely easy and worthwhile for people to participate. As the NPD continues to roll out and evolve, that will require thoughtful governance and continuous engagement from providers to ensure the directory continues to meet the needs of all parties. Successful adoption will need a similarly informed, ongoing implementation plan that encourages and enables onboarding and consistent use, to reduce effort and cost for all stakeholders.

Lessons from Oklahoma

LMI supported CMS’s design and deployment of a unified Qualified Health Plan provider directory pilot in the state of Oklahoma, delivering an integrated and scalable infrastructure to support approximately 80,000 healthcare providers statewide, as well as organizational administrators. We created a curated technology stack and secure web portal with an easy-to-use interface that enables users to update their records seamlessly, with the goal of ensuring that platform enhancements prioritized real-world usability and operational efficiency. We used an open-source data pipeline to enable wide participation in the curation and maintenance of accurate provider information, such as names, services, and practice locations. To enable other stakeholder systems to leverage information and make participation as painless as possible, the directory was supported by Health Level Seven® (HL7®) Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs).  LMI obtained an authority to operate (ATO), giving providers confidence that their data remained protected while accessible where it mattered. Finally, and perhaps most applicable, as the Health Tech Ecosystem truly gets underway, we established a structured feedback loop to continuously analyze user feedback so we could prioritize updates that reduce administrative burden, streamline stakeholder interactions, and accelerate adoption. Ultimately, the burden on providers was reduced by 75 percent, and the result was measurable improvements in provider data accuracy, administrative efficiency, and public trust. As important as the QHP system was, we succeeded by prioritizing engagement and adoption strategies.

Working smarter, not harder

From our work on the Oklahoma pilot, we know the NPD’s success will come down to participation. Physicians change practice locations, specialties, and network affiliations every day. A modern NPD must be capable of taking some of the burden off them by offering near-real-time updates through automated workflows. This isn’t a nice-to-have, it’s the difference between timely referrals and patients arriving at closed doors, and it’s the incentive providers need to collaborate. CMS should build on solutions that continuously cross-check provider information against authoritative databases and flag inconsistencies for human review, enabling continuous data integrity. This will deliver greater accuracy for patients and payers while reducing providers’ administrative load.

Maintaining engagement also means ensuring there’s a mechanism for understanding evolving needs without having to reinvent the wheel and force all parties to learn a new system. The directory will involve millions of contributors and users: providers, insurers, state agencies, federal entities, and beneficiaries. To succeed, it must be able to continue bringing those inputs into a single source of truth that remains accessible, adaptable, and sustainable, broadening the tent rather than taking it down and having to reopen it every few years, which would be a costly headache for everyone. If CMS can deliver a directory that is responsive and designed for adoption from day one, it has the potential to become one of the most impactful health data assets in the country. In fact, such a system could serve as a model for technology orchestration across the federal enterprise.

A good patient experience begins with a good provider experience. The organizations that help make participation seamless and data trustworthy will define NPD success at scale. LMI is focused on making both real— by enabling continuous validation, seamless integration, and everyday use.