Inaccurate Online Provider Directories Linked to Beneficiary Harm

Background: Medicare Advantage (MA) beneficiaries rely on their Medicare Advantage Organization’s (MAO) online provider directory to make informed health care decisions. There have recently been substantial media attention and anecdotal reports of inaccurate online provider directories. However, little empirical evidence exists on the extent of and reasons for such inaccuracies.

Program background: In 2014, CMS's Office of the Inspector General (OIG) received a congressional request to evaluate access to care for enrollees in Medicaid plans. However, during this evaluation, OIG discovered a myriad of issues with the directories used. In the 2016 Call Letter, CMS still noted “a range of issues with online provider directories.”

Evaluation Methods and Results: We investigated beneficiary complaints directly related to provider directory accuracy in order to measure and describe beneficiary harm due to online provider directory inaccuracies. We also surveyed MAOs regarding the processes and best practices in keeping directories up to date. In 2015 there were 101,940 beneficiary complaints submitted in the Health Plan Management System Complaints Tracking Module. We used random sampling strategy and designed a filter to screen for possibly provider directories related complaints. We found that 4% of all MA beneficiary complaints were related to provider directory inaccuracies. Over three-fourths (78%) of these beneficiaries received incorrect information from plan customer service representatives. Additionally, 14% of complaints indicated disrupted continuity of care, 8% could not access certain medical care, and 6% suffered financial penalties.

We also found that 60% of the surveyed MAOs don’t have call center scripts to handle beneficiaries notifying them of an error in the directory, 43% don’t display a date or time stamp of last update to the online provider directory, and 27% may not hear from a provider more than once every 6 months or a year. Reasons cited for these non-compliance include the complex and manual nature of making constant changes to the directory, inconsistency of communication with providers, the inability of providers or provider offices to provide accurate network information, and difficulties with technical systems.

Conclusions: Findings suggest that 1) the current MAO online provider directories are not ideal in terms of accuracy, 2) beneficiaries can experience real harm from these inaccuracies, and 3) the reasons for the inaccuracies are multi-faceted.

Implications for research and/or practice: This study offers valuable empirical evidence surrounding MAO online provider directory accuracy. Policy actions and outreach, as well as better coordination between health plans and participating providers, are needed to improve beneficiaries’ experience with and ability to rely on provider directories. MAOs can improve the accuracy of their directories by educating participating providers regularly on the plans/products they participate in, assigning clear roles for processing directory updates, and establishing protocols for finding provider information when an update is necessary.