Provider directory inaccuracy and timely access for mental health care.

OBJECTIVES: To evaluate the accuracy of provider directories for mental health providers and network adequacy, defined as timely access to urgent and general care appointments in California. STUDY DESIGN: We assessed provider directory accuracy and timely access using a novel, comprehensive, and representative data set of mental health providers for all plans regulated by the California Department of Managed Health Care with 1,146,954 observations (480,013 for 2018 and 666,941 for 2019). METHODS: We used descriptive statistics to assess provider directory accuracy and network adequacy assessed via access to timely appointments. We used t tests to make comparison across markets. RESULTS: We found that mental health provider directories are highly inaccurate. Commercial plans were consistently more accurate than both Covered California marketplace and Medi-Cal plans. Moreover, plans were highly limited in providing timely access to urgent care and general appointments, although Medi-Cal plans outperformed plans from both other markets when it came to timely access. CONCLUSIONS: These findings are concerning from both the consumer and regulatory perspectives and provide further evidence of the tremendous challenge that consumers face in accessing mental health care. Although California's laws and regulations are some of the strongest in the country, they are still falling short, indicating the need to further expand efforts to protect consumers.

Provider directory accuracy and timely access to mammograms in California.

Provider directory accuracy and access to timely appointments are crucial determinants of health outcomes. However, to our knowledge, no studies have analyzed provider directory accuracies or network adequacy for mammograms, an important preventive service. We fill that gap using large-scale, random, and representative surveys of provider directories and timely access for all managed care plans in California for mammogram providers, obtained from the Department of Managed Health Care for 2018 and 2019 for commercial, ACA marketplace, and Medicaid plans with more than 33,000 observations. Directory inaccuracies ranged from a low of 23 percent to a high of 38 percent. Consumers were able to schedule appointments with specific providers within 15 days in between 59 percent to 73 percent of cases. Comparisons of accuracy and adequacy between the three markets (commercial, ACA, Medicaid) were inconsistent. Even with one of the nation's strictest and most well-resourced regulatory regimes for provider networks, our findings show substantial inaccuracies and inadequacies exist.

Directory Accuracy and Timely Access in Maryland's Medicaid Managed Care Program.

We assessed provider directory accuracy and timely access in Maryland's Medicaid managed care program, using annual surveys from the annual random and representative provider surveys conducted on behalf of the Maryland Department of Health for 2018 and 2019. Based on 3,262 calls to 2,002 providers in 2018 and 2,739 calls to 2,033 providers in 2019, we found that provider directories are highly inaccurate. Insurance coverage could only be verified for 46% of the listed providers in 2018 and 56% of the listed providers in 2019. Among providers whose insurance participation was verified, beneficiaries were able to schedule timely general care appointments in 90% of verified providers in 2018 and 85% of verified providers in 2019; slightly more than 70% of appointments were scheduled on the first call. The success rate for urgent care appointments was lower but improved substantially once alternative providers were accounted for. Even for verified providers, timely access standards were often not met, particularly for general care. We also note the substantial variation across managed care organizations and across years. Our findings raise concerns from both an enrollee as well as a broader policy perspective. More oversight and enforcement are necessary to guarantee access to care.

Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California.

CONTEXT: The accuracy of provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes. METHODS: We evaluated accuracy and timely access data obtained from the California Department of Managed Health Care, consisting of responses to large, random, representative surveys of primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California. FINDINGS: Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. We found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of accurately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of accurately listed providers. Differences across markets related to accuracy were generally small. Medi-Cal plans outperformed other markets with regard to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments. CONCLUSIONS: Our finding raise questions about the regulatory regime as well as consumer access and health outcomes.