Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California
Context: Accurate provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes. We assessed whether consumers can rely on provider directories to find in-network primary care providers, cardiologists, endocrinologists, and gastroenterologist for 2018 and 2019 for all managed care plans in California and whether they can access these providers in a timely manner. Method: We used large, random, and representative surveys of provider directories for all managed care plans in California for four specialties obtained from the California Department of Managed Health Care with a total of 657,012 observations (290,711 for 2018 and 475,524 for 2019). Findings: Surveys were able to verify provider directory entries for the four specialties for 59 percent to 76 percent of listings or 78 percent to 88 percent of providers reached. Moreover, we found that consumers were able to schedule urgent care appointments for 28 percent to 54 percent of listings or 44 percent to 72 percent of appropriately listed providers. For general care appointments, the percentages ranged from 35 percent to 64 percent of listed providers or 51 percent to 87 percent of appropriately listed providers. Differences across markets were generally small related to accuracy. Medi-Cal plans outperformed other markets with regards to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments. Conclusions: Despite the fact that California is one of the most active and well-resourced regulators in the nation, we found concerning results for consumers when it comes to locating in-network providers and gaining timely access. This raises questions about the regulatory regime as well as consumer access and health outcomes.
|Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California
|CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
|October 28, 2021
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