Millions of people rely on health plan provider directories to find their doctors. However, over 80% of doctors had directory inaccuracies in key data elements, according to recent research published in the Journal of the American Medical Association (JAMA) by researchers at HiLabs in conjunction with the University of Colorado. One concerning result of these inaccuracies in aggregate is the creation of ghost networks. Ghost networks are doctors listed in provider directories but in reality are not accepting new patients or are unavailable for other reasons. Ghost networks have gotten a lot of attention recently, with renewed calls by legislators to tackle this issue in Congress. Ghost networks are very common and can worsen access to care issues. More broadly, the presence of ghost networks makes it hard for consumers to pick health plans. Consumers may be making their decision to choose a health plan based on the doctors available near them, but they would be misled by the presence of ghost physician entries. As Congress is urged to address ghost networks, health plans must take the initiative to solve this problem proactively. Artificial Intelligence is perfectly suited to address what is fundamentally a data quality problem.

This webinar will describe ghost networks, identify the root causes of ghost networks, and describe a technology solution to solve the ghost network problem. Specifically, advanced machine learning algorithms and AI can be trained to automatically identify and prune ghost physician entries. And the results can be surprisingly good for health plans, physicians, and patients. HiLabs has worked with many health plans using its AI algorithms in conjunction with a variety of internal and external data sources to solve this problem. One surprising result that has come out of this work is that improving provider directory accuracy actually increases network adequacy scores for health plans. We will describe in detail how other health plans can achieve these results.

The ghost network problem

- Congressional proposals regarding ghost networks
- Root causes of ghost networks
- Technology solutions to resolve ghost networks
- Strategies to increase network adequacy