Healthcare dataHealthcare data

Inaccurate healthcare data is costly for self-insured employers & employees

February 21, 2024
Madi Hornig

Healthcare data inaccuracies are widespread and cause significant downstream effects for consumers and self-insured employers alike. To combat these challenges, employers must take proactive steps to ensure their employees can find and access timely, cost-effective care.

Recent years have seen the U.S. healthcare system grapple with numerous challenges, from rising costs to accessibility barriers. Studies reveal that provider directory inaccuracies may be significantly contributing to these healthcare challenges. 

In this article, we explore the implications of data discrepancies on the healthcare landscape and the pivotal role self-insured employers can play in creating a better healthcare experience for their employees.

Unreliable provider directories

More than half of healthcare consumers rely on provider directories to find care, yet these directories are often plagued by inaccuracies. In fact, a recent study found that 81% of entries in directories of the five of the largest insurers contained errors. 

There are various reasons for these inaccuracies, including fragmented data sources and the sheer volume of changes occurring within the healthcare landscape each year. With up to 30% of directory information changing annually and providers juggling multiple payers’ requests for information, the likelihood of error is high.

Surprise bills

The most costly implication of inaccurate provider directories comes in the form of surprise medical bills. One in five Americans will inadvertently get care from out-of-network providers each year, with 30% of those receiving unexpected bills citing errors in their provider directories. 

The fallout extends beyond individual consumer expenses, impacting the overall healthcare costs of self-insured employers and eroding trust in the healthcare system.

Inaccessible care

Inaccurate data creates barriers to care, limiting patients' ability to access timely services. Important details like provider location, contact information, and network status are often misrepresented, leading to delays and denials of care. One study found only 26.6% of the directory listings for dermatologists in a Medicare Advantage plan were accepting the patient’s insurance, offering a medical dermatology appointment, and not a duplicate entry. This widespread issue makes it extremely difficult for patients to find and access care when they need it.

A path forward

In the face of these challenges, self-insured employers must take proactive steps to mitigate the impact of inaccurate healthcare data. Employers can play a pivotal role in shaping the healthcare experiences of their employees by:

  1. Educating employees: Employers can assist their employees by educating them on the importance of verifying network status and provider information before seeking care. Simple steps like calling the provider’s office before an appointment can prevent costly surprises down the road.
  2. Harnessing technology: Equipping employees with user-friendly navigation tools can revolutionize the healthcare experience. Some of these tools, like Amino’s digital guidance platform, cross-reference various data sources to minimize the risk of inaccuracy. 

By taking proactive steps to minimize the effect of data inaccuracies, employers contribute to a healthcare system that prioritizes the needs of patients and promotes the well-being of their workforce.

About Amino Health

Amino Health is the leading digital healthcare guidance solution. The only guidance platform that can handle the complexity of modern benefits programs, Amino makes it easy for members to navigate tiered networks, point solutions, incentive programs, and more. Amino replaces member confusion with confidence, ultimately driving cost savings, improved engagement with point solutions, and better health outcomes.

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