How Inaccurate Provider Data from Payers Impacts Access to Care

Consumers are calling on payers to make their online provider data more accurate to improve access to care in a survey published by Kyruus Health which HealthPayerIntelligence received by email.

Wakefield Research fielded the survey to 1,000 healthcare consumers in April 2024. Almost three-quarters of the respondents had private health insurance (72%), with Medicare as the second-highest source of insurance coverage (18%). The survey participants were evenly split between US regions and age ranges. Six in ten respondents were women (57%).

Historically, payers have struggled to keep their provider directories up-to-date, and this survey exemplified the downstream effects. Three in ten consumers skipped care due to inaccurate provider data (30%). They were most likely to seek this information online (70%).

Payers bear a lot of responsibility for directing consumers to the right data because consumers were most likely to consult a health plan website or app first when seeking out this data, with 32% of respondents saying that their insurers’ apps or websites were their first stop. Medicaid enrollees were particularly apt to rely on the plan website or app (64%).

In addition to websites and apps from their health plans, consumers conducted general internet searches, checked their provider or clinic’s websites, and consulted healthcare information sites like WebMD. Additionally, 77% of individuals who looked for care on social media used Facebook and 61% used YouTube.

In addition to providing false provider information, payers sometimes fail to present accurate cost predictions. Slightly less than a third of the respondents said that their health plans offered accurate cost information (32%).

Price transparency tools are especially important to younger generations. Millennials and Gen Z were very likely to use these tools (76% and 80%, respectively). In contrast, 40% of Baby Boomers did not know if their plans offered price transparency tools. When they use these tools, 34% of all consumers who used transparency tools and 45% of Gen Z members who used them found that the tools presented wrong provider data.

False information can have negative consequences for consumers, and it can also poorly impact healthcare stakeholders.

Consumers who found inaccurate provider information reported facing more steps before accessing care, being unable to contact their provider of choice, and experiencing higher costs. Some delayed or forewent care or received out-of-network care by accident.

In addition to these poor effects on members’ access to care, the participants’ experiences resulted in negative perceptions of their payers and providers. Overall, 80% of respondents found that inaccurate provider data impacted their trust. A quarter of respondents said the experience damaged their trust in their health plans (27%) and 22% said it diminished their trust in their providers.

Based on these survey results, the call to action is clear. Over six in ten consumers (62%) and nearly three-quarters of Gen Z members specifically (73%) want their health plans to present more accurate data.

The report recommended that plans take three steps in response to these results. First, they should connect with members through the appropriate channels, including social media. Second, they should unify their data so that provider information is accurate. And third, they should introduce self-service capabilities in their digital offerings.