Health care exchanges provided inconsistent physician data

Americans who signed up for health care coverage through health insurance exchanges had inconsistent access to provider information, according to a study published by the Robert Wood Johnson Foundation and the Urban Institute.

Researchers studied www.healthcare.gov and databases from nine states — California, Colorado, Connecticut, Massachusetts, Minnesota, Oregon, Rhode Island, Washington and the District of Columbia — and reported that only three states embedded physician directories into their health care marketplace websites.

Other state websites used external carrier websites to provide the data, which researchers wrote was inconsistent in format, making it difficult to compare plans.

“Embedded directories typically allow for fast and easy access, increasing the likelihood that consumers will use the directory and thus make plan choices that are more conducive to meeting their specific needs,” the researchers wrote. “Embedded directories also make it easier for consumers to compare directories across different carriers and plans, as well as eliminate the complexity of locating a desired Marketplace plan in an external directory.”

According to the report, of the three states that embedded the directories, Massachusetts’ site “functions best” and is easier to search.

The health care marketplace in Washington was described as “encouraging,” but physicians cannot be filtered by specialty.

Search functionality also was investigated and shown to be inconsistent.

“Findings from this study indicate that consumers’ ability to effectively search for a physician within any of these scenarios [finding an existing provider, specialty physician or a medical group] is highly dependent on their state, with state and federal effectiveness in presenting provider directory information varying substantially,” the researchers wrote.

The embedded search function on the exchange website in Massachusetts allows consumers to search by ZIP code and chosen radius from the area and refine results by specialty, languages spoken, hospital information, gender and whether or not the provider accepts new patients. Consumers can select up to five physicians to learn which, if any participate in one of the plans, but there is no means to view a list of all physicians in a given plan.

According to the report, the search results are easy to read and use visuals such as a green check mark for those who accept a plan or a red “X” for those who do not. Researchers praised the clear display of information and geographic search of the Washington website, but said no comparison feature exists. Limitations to filtering by specialty also were noted.

Colorado’s exchange website was reported to allow consumers to search physicians by name and select plans that include them, but if consumers misspelled names or abbreviated terms in the database, usability became limited.

“There is significant room for improvement in physician search functionality both at the state-Marketplace level and at the individual-insurer level,” the researchers wrote. “To enable a seamless physician-search experience that is comparable across insurers, states should create embedded provider directories for each insurer.”

For more information:

Blumberg LJ. 2014. Physician Network Transparency: How Easy Is It for Consumers to Know What They Are Buying?