The pervasiveness of inaccurate provider data in behavioral healthcare

Misha Nazrollahzadeh
August 10, 2021

A closer look at how poor provider data prevents access to behavioral healthcare

One out of five adults in the United States experiences mental illness, while one in 20 lives with a serious behavioral healthcare condition. During the COVID-19 pandemic, the number of people reporting anxiety and depression symptoms has risen from a baseline of 11 percent to a staggering 42 percent. Yet more than 55 percent of adults affected by mental illnesses don’t have access to care. And of those who do, it can cost a whopping $10,000 per year to treat.

These statistics are overwhelming, especially for those patients attempting to get help for a behavioral health concern. A surge in demand, coupled with an insufficient number of clinicians, is a major part of the problem. But there’s a not so surprising culprit making it even more difficult to access care: a high number of inaccuracies in provider directories that make it nearly impossible for some patients to identify the right providers, contact their offices or even use their insurance to cover the bills.

Sky-high error rates in provider directories block access to affordable care

Finding a behavioral healthcare provider who practices in an accessible location, is accepting new patients, and takes the right insurance can be likened to winning the lottery. In one experiment from the Cambridge Health Alliance, researchers posed as patients in need and called 360 psychiatrists in three major cities seeking appointments. They only managed to connect with two-thirds of providers in two rounds of calls. Just 26 percent of the 360 professionals were accepting new patients at the time.

Error-filled provider directories were largely to blame for being unable to reach more providers.  Sixteen percent of the phone numbers dialed were simply wrong.  A follow-up study focusing on pediatric patients found the same issue, with researchers citing incorrect contact information as the top reason why they couldn’t connect with care providers.

A separate study from Yale and NYU revealed similar concerns: more than half of mental health patients who used a provider directory to locate care encountered errors in the data.  To add insult to injury, patients who encountered directory inaccuracies were twice as likely to be treated by an out-of-network provider—and four times more likely to receive a subsequent surprise medical bill.  

For individuals already struggling with behavioral health conditions, a surprise bill can be devastating. Patients may be less likely to continue treatment or may be unable to afford to pay for other critical expenses, such as primary care and prescriptions, food and housing, or additional existing debts.

Why are behavioral healthcare provider directories riddled with inaccuracies?

We know that keeping provider directories up to date is an ongoing challenge. Providers often alter their affiliations, practice sites, and licensing statuses—up to 30 percent may make one or more changes per year, according to IDC Health.

Healthcare organizations—from digital health startups to health plans—are often unable to keep up with these changes. Sometimes, providers simply don’t report the new information. Other times, a lengthy publishing process means the new information doesn’t make it into the public-facing directory before it changes again.  

That’s because the process for collecting, cleansing, verifying, and updating provider information is still, for the most part, manual. For example, some health plans rely on providers to share their updates with every one of their contracted plans. They don’t have access to verified real-time data sources for speedy corrections. And many don’t have the resources in-house to implement AI tools to scale the process of identifying the most current information in a sea of incorrect data points.  

These methods leave patients frustrated with directories that don’t actually help them find providers who can meet their needs. With the demand for behavioral healthcare on the rise, healthcare organizations can’t afford to leave their members without trustworthy, accurate provider directory resources.  

Changing the status quo with innovative technology solutions

Fortunately, there are ways to improve provider directories and ensure patients can make the best possible decisions about their behavioral health.

Incorporating enhanced automation into the provider directory workflow can significantly improve the timeliness and accuracy of network data. AI can regularly examine relevant data sets to flag changes in provider status, while machine learning algorithms can verify and validate the information without playing phone tag with busy provider offices.

With additional capabilities, such as Ribbon’s Provider Focus Area offering, healthcare organizations can get even more granular with provider specialties, allowing patients to correctly identify the best possible professional to meet their specific needs. These tools are available through easy-to-implement APIs that significantly reduce manual workflow burdens and ensure that patients are getting the right information at the right time.

Improving provider directories is a critical step toward solving the mental healthcare crisis. With better data and strong support from their health plans, millions of individuals can overcome their challenges and engage with affordable, effective care for mental illnesses and behavioral health conditions.  

To learn more about how Ribbon can help you drive high-quality, cost-effective healthcare decisions, get in touch with us today.

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