What You Should Know:
– Incorrect data in health plan physician directories is a pervasive problem, according to new research conducted by researchers at University of Colorado and HiLabs.
– The study, published in BMC Health Services Research, leverages HiLabs AI algorithms to compare data for >40% of US physicians across five large health plan directories.
Key Findings:
- Limited variation in data quality between insurers suggests the issue goes beyond individual insurer practices.
- Physician practices, burdened with updating information across multiple platforms, contribute to the problem.
- Specialties like primary care and dermatology have higher data accuracy, potentially due to greater patient interaction.
- Considerable variation exists between states, with reasons unclear and requiring further investigation.
The Impact:
- Patients can face delays in care due to incorrect contact information.
- Surprise billing can occur if a network-listed provider is out-of-network.
- Consumers struggle to compare health plans based on inaccurate provider listings.
Proposed Solutions:
- Centralized Directory: The Centers for Medicare and Medicaid Services’ proposal for a unified national directory is an option, but challenges exist, including ensuring accuracy and requiring a major shift in data exchange practices.
- National Standards: Establishing national standards for how provider information is exchanged could be a less disruptive solution.
- Engaging Physician Groups: Future policy solutions should involve both insurers and physician groups to improve data accuracy.
International Comparisons:
- Many countries have centralized directories, but inaccuracies have been documented even in government-run systems.
- Australia’s recent launch of Provider Connect Australia (PCA) is a model to watch for its potential to improve data quality and access.
The Takeaway:
Inaccurate provider directories are a major problem in the US healthcare system. Novel policy solutions are needed to address this issue and ensure patients have reliable information to access the care they need.
“We are proud to collaborate with University of Colorado researchers to use our AI for this important study,” said Amit Garg, CEO of HiLabs. “At HiLabs, we have seen tremendous interest from health plans in using AI algorithms to uncover provider directory inaccuracies in recent years and have seen substantial improvements in directory accuracy as a result.”
For further information and to access the full study, please visit https://doi.org/10.1186/s12913-024-11269-5
