Provider Mismatch – Frustrating for Patients, Disruptive for Providers, Painful for Payors, Costly for Everyone

Provider mismatch, or poor matching between the patient’s needs, the provider’s service, and the payor’s coverage is frustrating and expensive at every step of the healthcare journey. As more of healthcare moves online, scheduling and communications among providers, patients, and health plans is conducted via web sites and apps. The aim is to improve efficiency and accuracy, but too often the results fall far short of the mark.

Patients

Patients invest time and effort to book appointments for the specific care they seek. Today this often means navigating one or more online scheduling systems with little or no guidance. Too often, a patient spends time and money to show up for their appointment, only to discover that the provider they’re seeing can’t help them or is not in their coverage network. The result can be surprise bills, delays in necessary care, and potentially poor health outcomes.

“You don’t want a patient scheduling with an orthopaedic provider who treats spines when they have a shoulder injury,” said Sara Grahek, Director of Clinical Services at HSHS. “It’s not a good experience for the patient or provider.” 

That list of needs seems simple, but when patients feel under-served, they don’t stay around. A survey detailed in Fierce Health Care reports that

• 1 in 5 patients left a provider due to a poor digital experience 
• 41% said they’d consider switching to a provider who offered a better digital experience

The same survey reveals that the younger the patient, the more likely they are to express – and act on – dissatisfaction with bad digital experiences. Patients aged between 18 and 24 are three times as likely (61%) to consider switching providers over a poor digital experience, compared to those over 65 (21%). Younger patients are four times as likely (29%) to have already abandoned a provider due to a poor digital experience compared to the over-65s (6%). It should be no surprise that frustrated patients post low satisfaction ratings and unfavorable reviews.

Providers

Providers allocate appointment times for specific visit reasons, using scheduling systems designed to maximize revenue by lining up as many patient appointments as possible. Unproductive appointments waste valuable schedule slots, leading to a loss of revenue and productivity. Each no-show costs physicians an average $200 and 60 minutes, according to Healthcare Management Technology. The resulting delays and appointment rescheduling from a provider mismatch can also set off a chain reaction of poor ratings and reviews from dissatisfied patients that can have a negative impact on patient acquisition down the line. 

Providers also spend considerable time and money maintaining their directory profiles, and unproductive appointments don’t produce any return on that significant investment.  

According to a survey by the Council for Affordable Quality Healthcare (CAHQ), “Physician practices across the US spend $2.7 billion every year just on verifying and updating directory information for plans. The average practice dedicates one staff day per week to the task.” 

Payors 

Federal and state laws require health plans to make directories available to help their members choose and contact in-network providers. These familiar listings typically include location, hours, whether they accept new patients and other pertinent information. But, as reported by HealthIT Consultant, inaccuracies are common:

• In a January 2018 survey released by the American Medical Association (AMA), 52% of physicians said their patients encounter coverage issues at least once a month due to inaccurate information in directories

• Since 2016 the Centers for Medicare and Medicaid Services (CMS) has studied the accuracy of online directories in a sample of Medicare Advantage Plans. These studies, published as the Online Provider Directory Review Report, consistently find that nearly half of the practice locations listed are incorrect.

Recommendations

In today’s consumer-driven environment, patients expect low-friction interactions that resemble the most popular online shopping experiences. Here are some ways healthcare providers and payors can re-think their patient or member experiences and avoid provider mismatch:

Don’t lock up information inside a patient portal. Portals are standard for established patients, but they are not useful for the beginning of the relationship when the consumer is shopping for healthcare. People who want to know where and how to contact a provider for their medical needs, and what they can expect to pay for a common procedure, should be able to find this information without logging in to an environment designed for existing patients.

Compare your patient relationship tools to other industries such as travel, financial services, or retail. According to the Harris Poll, 81% of respondents feel “shopping for healthcare should be as easy as shopping for other common services.” Patients are consumers, and they expect the same welcome and ease of use they value elsewhere online. According to Harris Poll, only around a third of consumers feel their provider or insurance plan communicates with them too much, and more than two thirds say they want their health plan and provider to communicate using more modern platforms.

Next Steps to Avoid Provider Mismatch

Payors and providers can help guide patients to the right care, and avoid surprise bills, by offering improved patient navigation tools and more efficient provider data management:

• Empower patients to filter providers by their accepted health plans, in both find-a-doctor tools and online scheduling utilities
• Enable members to search for in-network providers, and schedule appointments directly via their health plan’s portals and apps
• Providers will need to adopt a robust data management solution to update consumer-facing applications with important consumer information such as what insurance a provider accepts, integrated with the convenience of online appoint,ment scheduling 

For more insight on improving telehealth access and boosting patient engagement, download the DocASAP eBook Telehealth: Taking the Pulse of the Healthcare Consumer in the New Normal, and check the section “Strategies for Optimizing Telehealth”