How to Combat Ghost Networks to Improve Access to Care

How to Combat Ghost Networks to Improve Access to Care

Congress is shining a light on a topic that the entire healthcare industry struggles to address — “ghost networks” — after a study found that more than 80 percent of mental health providers listed in health plan directories were either unreachable, not accepting new patients or out of network.

"Ghost networks" refer to healthcare providers who are listed in a health plan's network directory but are not actually available to patients (in other words, they’re ghosts). This happens as providers retire, change practices and move — all normal behaviors.

Keeping provider directories current is an ongoing task. In fact, up to 2.5 percent of provider data becomes outdated each month, resulting in 20 to 30 percent being incorrect by year’s end, according to provider directory cleansing company Orderly Health.

The result: simple confusion and frustration at best, and serious access to care challenges at worst for patients who may find it difficult to receive the care they need.

The Senate Committee's study highlights the need for better provider search and scheduling solutions to counteract the growing access to care problem that members face. And, if Congress is to hold payers accountable for inaccurate provider directories as Senate Finance Committee Chair Ron Wyden suggests, they should also offer a solution. So, what can health plans actually do about ghost networks?

One way for Medicare Advantage plans in particular to address ghost networks is to partner with digital health solutions that help curate their network, identifying and removing the ghosts while simultaneously connecting members with available providers within their plan's network. Rather than force members to sift through outdated directories, these solutions ensure that members receive the appropriate level of care with convenient, in-network providers with the right specialty and sub-specialty.

In addition, solutions such as these offer a significantly better member experience, as they ease the burden of finding and scheduling care by engaging a care navigator to book appointments for the member.

So, instead of a laundry list of non-existent providers, members get a filtered, personalized list of doctors who match their needs, including:

  • Specialty and sub-specialty, and special equipment and services offered
  • Available appointments in the next week
  • Speed of response
  • Plan-preferred or “high value” specialists
  • Telehealth options
  • And other custom filters specific to health plans

Of course, it's also important for Medicare Advantage plans to regularly review and update their provider directories to ensure accuracy and availability of listed providers (Orderly Health is one we recommend). Plans can also work to improve member engagement and communication, providing them with resources and information to help them navigate their healthcare journey and make informed decisions about their care.

As with most challenges in healthcare, a multi-faceted approach is likely the best answer for health plans. As always, just getting started on this journey is the key. And, by combining digital health solutions like ReferWell that advance
health equity and access to care with proactive efforts by Medicare Advantage plans, the industry can effectively and efficiently address the problem of ghost networks.

Identify the member's perfect match provider

Written by Vytas Kisielius

Vytas has a long career building successful companies in many different capacities across the financial, IT and healthcare sectors. As ReferWell’s CEO, he works tirelessly to ensure ReferWell thrives within the market. Vytas draws on his extensive experience in creating a cohesive, hard working team while building and executing a focused strategy aimed at leading the way in revolutionizing healthcare delivery.

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