“We go beyond just verifying a provider’s existence and capture real-time appointment availability to ensure members are connected with providers who can see them right away.”
Tim McIntyre – Director of Provider Enablement
Last year, Senate Finance Committee staff made a startling discovery: more than 80% of mental health providers found in insurance directories from 12 plans in six states were unreachable, not accepting new patients, or were not in-network at all. These inaccurate directories — commonly known as “ghost networks” — include multiple providers who cannot meet the needs of the patients they claim to serve, setting them up for failure before their care journeys have even begun. While Congress mulls imposing penalties on these health plans for misleading consumers, the real-life consequences of ghost networks persist.
In our recent “Key Strategies for Eliminating Ghost Networks” webinar, Lucet SVP of Provider Success Visar Tasimi and Director of Provider Enablement Tim McIntyre discussed how Lucet’s proactive approach helps combat the problem by managing provider networks to ensure databases remain updated, thereby enhancing accessibility and minimizing discrepancies in patient care.
Understanding the complexity of ghost networks
During the session, Visar addressed the fundamentals of the problem, noting that the complexities surrounding ghost networks are multifaceted, rooted in the dynamic nature of health care provider data. Provider retirements, relocations or changes in practice ownership contribute to the emergence of ghost networks. The critical challenge lies in the time lapse between such changes and the management of data within health care systems. This lag leads to inaccuracies and disruptions in patient care, exacerbating the issue.
Strategies to combat ghost networks
Tim highlighted the unique elements of Lucet’s approach to addressing ghost networks, going beyond traditional geo-access measurements. Among the key strategies Lucet employs to combat this critical problem include:
Data analytics
“We perform comprehensive analyses of health plan data to identify potential ghost networks. This includes looking for inactive providers, outdated information, and gaps in provider supply compared to member demand.”
Real-time availability
“We go beyond just verifying a provider’s existence and capture real-time appointment availability to ensure members are connected with providers who can see them right away.”
Provider engagement
“We work with providers to ensure they have the information and tools they need to continue to keep their directory listings up-to-date. This includes capturing languages spoken and cultural backgrounds to improve patient matching.”
Flexibility
“One notable aspect of our approach is our flexibility in partnering with health plans and providing tailored support to enhance network effectiveness. Through regular feedback sessions and ongoing support, Lucet ensures providers are continuously equipped to deliver quality care and address patient needs effectively.”
Stay tuned for more Lucet Webinars with our experts and valued partners.
Visar Tasimi is SVP of Provider Success, Tim McIntyre is Director of Provider Enablement, and Britta Nordstrom is a senior marketing specialist at Lucet, The Behavioral Health Optimization Company.
