As consumers seek new health plans, directories often fall short
The last three months of the year find growing numbers looking for provider information, but doubts swirl around these lists.
Going through our mail last week, I found a large envelope from our health insurer addressed to my wife. They’re just explanations of benefits docs, I thought, without opening it.
Then I found an identical large envelope addressed to me. Oh no….
Yes, we were being notified that the insurer won’t be offering our Medicare Advantage plan and that “you need to make decisions about your Medicare coverage.” It became clear that we were going to be embarking on the great investigative adventure of finding new health coverage. Time to ferret out information, make calls and then make choices.
Ours will not be an unusual story over the next few months, as many hundreds of thousands of Medicare beneficiaries will be looking for new coverage. Several major insurers have announced intentions to reduce the number of Medicare Advantage plans in 2026. This week, CVS Health, Humana and UnitedHealth Group announced they will pull back on Medicare Advantage offerings next year.
More churn in the market is likely, as the federal government implements regressive changes to healthcare funding, including cutbacks to Medicaid funding and expected resulting increases in health insurance costs because of uncertainty over the future of healthcare subsidies for those covered by the Affordable Care Act. That will heighten the need for solid, reliable information on providers, networks, coverage, costs and more.
That likely will mean wider use of provider directories in the next weeks. Unfortunately, recent research suggests that these directories are still missing the mark in terms of accuracy and utility.
Provider data pain points
An Ipsos survey of 3,014 adults “highlight the need for healthcare organizations to modernize the provider directory experience,” notes a summary of findings from LexisNexis Risk Solutions, a well-known provider of data and analytics for the healthcare industry.
The survey data provides a glimpse of whether and how consumers use healthcare provider directories, taking a deep dive into how inaccurate provider data, low awareness and poor usability may be hindering wider use. The results bear increased relevance given the extent to which consumers will be investigating their options over the next three months.
Perhaps the best news is that a large majority of adults (82 percent) have used provider directories. Unfortunately, a sizeable number of those users question the validity of the information and report challenges in using the directories.
Some 33 percent of provider directory users say they have encountered outdated or incorrect information. And more than one out of five (21 percent) say they find it difficult to use a provider directory to find providers.
That calls into question how these directories can meet the needs of consumers as they shop for coverage or as older primary care clinicians retire from the workforce. As the LexisNexis report states in its preamble, “Amid ongoing provider shortages, an aging population and the growing burden of chronic disease, finding the right healthcare provider is more important than ever. Provider directories can play a vital role in connecting individuals to care, but their value depends on accuracy and reliability.”
A wasted resource?
Directories are more than lists of names and related generic information. In many cases, they’re one of the places that consumers turn when they’re looking for crucial assistance as they face life-threatening illnesses.
The LexisNexis report found that consumers “rely on provider directories for critical healthcare decisions, such as finding a specialist (noted by 49 percent of respondents) or confirming a provider is within a network (46 percent).” Almost a third of consumers say they consider network participation “as the single most important factor when searching for a provider that meets their needs.”
Lack of familiarity with or diminished trust in provider directories is pushing consumers to other sources of information on healthcare providers, researchers suggest.
“Usage of digital healthcare directories lags behind traditional referral methods,” the report noted. “More than half (52 percent) of respondents report they rely on doctor referrals, and 46 percent report they rely on referrals from family and friends.”
The researchers conclude that healthcare organizations must become more active participants in the work to ensure provider directories are up-to-date, accurate and useful to users.
“Many users – especially those managing care for entire households – face outdated or incorrect provider information, exposing a widespread issue in digital healthcare navigation,” researchers note. “This inconsistency erodes trust and creates barriers to timely, appropriate care.
“To address this, healthcare organizations must take a more proactive and strategic approach to improving the reliability and accessibility of their provider directories.”
Now more than ever, provider directories will be increasingly used and scrutinized for their utility. The prognosis, at least according to this survey’s results, looks iffy at best.