Maryland health exchange administrators are considering ways to improve accuracy of its doctor database and the availability of listed providers.
Exchange administrators are concerned that the state-run provider database used by people signing up for private health plans through Maryland Health Connection is riddled with inaccuracies and that few of the doctors listed for certain specialties are able to see new patients within a few weeks notice.
In response, the board is considering new regulations for insurers to update doctor information and new options for consumers to report errors. The board plans to flesh out these rules — and a way to enforce them — as part of an update to requirements for 2017 health plans.
The state-run doctor database includes thousands of listings for doctors who are part of the networks for health plans sold through Maryland Health Connection. Doctors must provide updated contact and availability information to insurers and insurers send this information to CRISP (Chesapeake Regional Information System for our Patients), the state health information exchange that manages the database.
A study by the Maryland Women’s Coalition for Health Care Reform released Nov. 18 found that less than a quarter of some 1,500 OB/GYN doctors listed in the state-managed online provider directory for health plans bought through Maryland’s health exchange are accepting new patients and could provide a basic check-up within four weeks. Mental Health Association of Maryland board found similar problems among mental health providers listed in the directory.
The exchange board established a subcommittee to study the issue and on Monday heard the group’s recommendations.
To improve accuracy, the exchange could establish requirements about how often insurers must provide updated information to the database. Another option for reducing errors is to establish a way for consumers to report problems, such as an incorrect phone number or inactive listing. The health exchange in Washington, D.C., has a similar consumer reporting system for doctor directory errors.
While exchange board members and exchange administrators agreed that they must do something to improve accuracy of the doctor directories, there was not consensus on exactly how they should go about holding insurers or doctors accountable for making sure information is up-to-date.
The exchange could impose financial penalties or even de-certify plans if insurers failed to meet reporting requirements. But these measures could ultimately hurt consumers, who would have to find a new plan if theirs was suddenly de-certified.
Carolyn Quattrocki, the exchange’s executive director, said that ideally the agency will develop a way to improve accuracy that works with insurance companies to get the information right.
Leni Preston, chair of the women’s health coalition, said she was encouraged by the board’s discussion, which she said showed the board takes seriously the task of improving consumer access to health care.
But it could still be a while before consumers see any change.
The board is considering these new regulations as part of an update to requirements for 2017 plans.
Date: November 24, 2015