Health

One big reason healthcare access is hard – MedCity News

People are starting to come back to doctors, but healthcare access remains difficult. “Pent-up demand” is the term from industry pundits as we emerge from shutdowns in specialty care. Healthcare systems are focused on recovery — filling up schedules for electives.

Despite all that has changed about healthcare access in the past year, one thing has unfortunately remained unchanged – the care access journey.

Patients continue to rely on insurance providers and Google to find care. They are looking for answers to these top three questions:

  1. Insurance: do they accept my plan?
  2. Location: are they close to my home or work?
  3. Reputation: what do patients say in ratings and reviews?

Finding answers to these essential questions is often difficult and frustrating. My own exasperating journey to healthcare access started with a recent search for a doctor.

The Digital Front Door Is Closed

I started as most consumers do — with my insurance card. I’m fortunate to have a fantastic PPO with the nation’s largest payer. In theory, I can get care anywhere. But, after failing to access the list of providers, I gave up and called the employer’s third-party administrator.

With a tone implying she gets this inquiry daily, the operator talked me through a series of clicks to end up on a separate website with the provider physician directory for my plan. I was 30 minutes into my task, but I’d finally made it to the correct place and began my search with gusto.

Find a Doctor (Or At Least Try)

The payer’s “Find-a-Doctor” pulled up 66 physicians based on my search criteria, but had limited info — no photos, bios, or ratings and reviews. So I took the next step most consumers do in the search for healthcare access — I Googled.

The first physician appeared on Google My Business with a different address about 40 miles away from what the insurance website indicated and labeled “Permanently Closed.”

When I called the number for the “closed” office, a staff member explained that neither Google, the insurance website, nor their own website were correct. Instead, I got a fourth address, which wasn’t listed online. She also informed me of a new doctor with office hours near me. But, this provider did not show up as part of my in-network options. Attempting to reassure me, she explained new providers are often missing data and to keep checking back for updates in the coming weeks.

I moved to the next person on my shortlist from the insurance website. Again, Google showed a different location from the insurance directory. I was zero for three so far. Next was a quick search and another “permanently closed” attribution on Google.

I tried very hard in the search for healthcare access. I’m a qualified lead with great insurance. But after more than an hour spent trudging through five websites, three phone calls and many Google searches, I accepted defeat.

The Data Problem – and What to Do About It

I was foiled by disconnected provider data that health systems and payers have yet to optimize at scale. This problem recently caught the attention of the San Diego City Attorney’s Office, which accused some providers of operating “ghost networks” that frustrate patients “with repeated, failed attempts to obtain coverage using the inaccurate directories.” The San Diego City Attorney’s Office alleges payers violated a California law requiring insurance companies to keep provider directories accurate and updated.

I’ve worked with many health systems and payers, and I understand why challenges exist. Disparate databases, credentialing systems, and a glut of point solutions make it extremely difficult to govern provider data, let alone serve it up to consumers in a way they can digest. Because of my experience, I knew exactly where to look, and yet I came up empty-handed. If it was this hard for me, imagine how difficult it is for the average consumer to access care.

While the problem is complex, the solution is deceptively simple: data governance. Creating a “single source of truth” is the boring, thankless foundation upon which all marketing and patient experience efforts must be built. Manage all provider data in a master hub, and everything else – your website, third party listings and payers – can draw directly from this source.

Healthcare Providers Face Pressure from Google

Google is forcing healthcare’s hand when it comes to the data, most recently around insurance transparency. Google My Business now has an attribute for “Insurance Accepted” that appears on healthcare listings. If brands don’t manage this data, Google will automatically update the information by scraping data from third party sites. The message to healthcare is clear: own this data, or Google will do it for you.

Of all online searches, 65% of those will result in a conversion right within the results page, meaning the consumer will never even click through to your website. Healthcare brands invest enormous sums of money in marketing campaigns, websites, and apps that will never be effective until a consumer can overcome the data barriers to healthcare access. Data is not a glamorous issue for healthcare executives. It doesn’t sound as interesting as “reimagining consumer experience” or “clinical digital transformation” in a press release. But until the data foundation is rebuilt, consumers will struggle to access care.

I’ll try my own search again tomorrow. But for now, the demand will remain pent up.

Photo: Aleksei Naumov, Getty Images

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