July 23, 2019

Google offers more accurate provider information than many health plan directories, according to a study recently published in the American Journal of Managed Care.

For the study, Austin Frakt—a health economist who holds positions at Veterans Affairs, Boston University's School of Public Health, and the Harvard T.H. Chan School of Public Health—and other researchers examined the accuracy of various health plan provider directories by reviewing CMS' National Plan and Provider Enumeration System (NPPES) file, Medicare Advantage (MA) directories found on health plans' websites and other online sources, machine-readable (MR) health insurance directories for exchange plans, and Google Places in five counties.

The researchers determined accuracy by contacting provider practices and using text-matching techniques. They also interviewed 21 stakeholders, including CMS officials and state regulators.

Findings

The researchers identified three types of inaccuracies across provider directories:

  • The directories contained incorrect information for an in-network provider;
  • The directories listed out-of-network providers as in-network providers; and
  • The directories omitted in-network providers.

According to the researchers, Google Places provided more accurate provider information than conventional MA directories, and conventional MA directories provided more accurate information than MR directories for exchange plans.

For example, the researchers said they were able to confirm 73% of providers' address information listed on Google Places, compared with 72% in MA directories, 67% in CMS' NPPES file, and 65% in MR health insurance exchange directories:

The researchers also found that directories from the same insurer in some instances included conflicting information. The researchers wrote, "We … found that provider directories from insurers with MA and exchange plans did not report the same phone number 50% of the time and did not list the same address 31% of the time."

The researchers attributed the inaccuracies to:

  • A lack of consistent standards for provider information;
  • Providers' failure to prioritize updating directory information; and
  • The federal government's failure to develop a strategy to address inaccurate health plan directories.

Discussion

Michael Adelberg, the study's lead author who has held senior positions at CMS and currently leads health care strategy at the law firm Faegre Baker Daniels, said, "Directory accuracy is hard. But when a consumer joins a plan to get to a doc in the directory and then cannot, that consumer has a very legitimate beef."

Overall, the researchers recommended that, to address the directory inaccuracies:

  • CMS and other entities require health plans to use MR directories, which the researchers said are easier to download to evaluate the adequacy of a health plan's network or a network's breadth;
  • Federal policymakers clarify their role in addressing directory inaccuracies; and
  • Regulators and researchers identify best practices for improving a directory's accuracy (Haefner, Becker's Payer Issues, 7/10; Frakt, "The Upshot," New York Times, 7/8; Adelberg et al., American Journal of Managed Care, 5/15).

Health Insurance 101: Get the slide decks

Back by popular demand: This webconference series includes four online sessions which will cover the fundamental aspects of health insurance structure and delivery, updated to review the latest trends in the industry.

Register Now
Download Now

Topics