Directory Accuracy and Timely Access in Maryland's Medicaid Managed Care Program

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Provider directories are crucial for patient access to healthcare services.
• Accurate and up-to-date provider information is essential for effective managed care.
• Previous research indicates challenges in provider directory accuracy within public health programs.

Purpose of the Study:

• To evaluate the accuracy of provider directories in Maryland's Medicaid managed care program.
• To assess the timeliness of access to general and urgent care appointments for beneficiaries.
• To identify variations in directory accuracy and access across managed care organizations and years.

Main Methods:

• Utilized annual random and representative provider surveys for Maryland's Medicaid managed care program in 2018 and 2019.
• Conducted 3,262 calls to 2,002 providers in 2018 and 2,739 calls to 2,033 providers in 2019.
• Assessed insurance coverage verification and appointment scheduling success rates for general and urgent care.

Main Results:

• Provider directories demonstrated significant inaccuracy; insurance coverage was verified for only 46% (2018) and 56% (2019) of listed providers.
• Timely general care appointments were scheduled with 90% (2018) and 85% (2019) of verified providers, with over 70% scheduled on the first call.
• Urgent care access improved with alternative providers, but timely access standards were frequently unmet, especially for general care.

Conclusions:

• High provider directory inaccuracy and challenges in timely access to care raise significant concerns for Medicaid beneficiaries.
• Substantial variations across managed care organizations and years highlight systemic issues.
• Increased oversight and enforcement are necessary to ensure beneficiaries can access necessary healthcare services.