During the COVID-19 pandemic, governments changed rules and procedures related to Medicaid enrollment. These changes…
School of Public Health study found significant inaccuracies in managed care plans’ provider directories affecting timely access to care
Ensuring better access to health care has long been a goal for policy makers. The implementation of the Affordable Care Act more than a decade ago set the stage for expanded coverage through insurance marketplaces and Medicaid expansions. Research has focused on how expanding coverage affects access to timely health care; however, fewer studies have focused on other challenges to health care access such as inaccuracies in provider directories.
A recent study published in the Journal of Health Politics, Policy and Law analyzed provider directories for managed care plans in California, one of the largest and most regulated insurance markets in the country, to measure provider listing accuracy and access to care. Simon Haeder, PhD, associate professor in the Department of Health Policy and Management at the Texas A&M University School of Public Health, and a colleague from Yale University used data from statewide surveys of primary care physicians, cardiologists, endocrinologists and gastroenterologists in 2018 and 2019 to determine the percentage of provider directory listings that are accurate, whether consumers can get timely access to care and if there are differences between provider specialties and types of insurance.
Insurers publish directories of health care providers in their networks as a way to help consumers access care. Having accurate provider directories is crucial because even the best insurance plan is no help to consumers if they cannot find a provider who is in-network and taking appointments. Research has found that provider directories often contain inaccuracies such as incorrect contact information and sometimes even include providers who are not in-network, retired or are not taking new patients. State and federal governments have passed laws requiring regular reviews of provider directories and giving consumers ways to report inaccuracies, but the efficacy of these laws is somewhat unclear.
The researchers reviewed provider directories for commercial, Covered California and Medi-Cal plans. They attempted to contact providers by email, phone and fax and verified that the providers practiced their noted specialty at the listed location and that they offered appointments. The research team then asked when the next available urgent and non-urgent appointment times for existing and new patients would be. Their review included 153 health plans for 2018 and 160 plans for 2019, covering more than 760,000 unique provider-plan combinations.
The analysis found varying ranges of accuracy in provider directories for the different specialties and plans. There were inaccuracies for about 24 percent of the primary care providers in commercial insurance lists for 2019. At the other end of the range, about 41 percent of endocrinologists in Medi-Cal provider lists for 2018 were inaccurate. Overall the primary care listings were most accurate, followed by cardiology. The analysis also found that consumers could only schedule urgent care appointments for 28 to 54 percent of the listings; however, this increased to 44 to 72 percent when including only accurately listed providers. Non-urgent appointments ranged from 35 to 64 percent for listed providers, but increased to 51 to 87 percent for accurately listed providers. Accuracy and timely access were generally better for 2019 than 2018 and both were improved compared to a previous study from 2015.
Findings of this study highlight notable flaws in provider directory accuracy and timely access. Additionally, correcting errors in directories may improve timely access, but it does not fully alleviate concerns about consumers being able to get the care they need. The researchers note that these findings raise concerns about the efficacy of regulations in California, and by extension, other states where insurers are not as thoroughly regulated, such as Texas.
The analysis identifies a need for further study into provider directory inaccuracies and their effects on inequities in health outcomes. Additionally, there is a clear need for more research into regulations themselves to determine which approaches are more effective at improving timely access to health care. Ensuring accurate provider directories and timely access to care is likely as important as expanding health care coverage to improve health outcomes, though accomplishing these tasks may prove more challenging.
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