California ‘secret shopper’ study discovers limited access to preferred doctors
A recent study indicates that insured patients have a difficult time scheduling appointments with their preferred physicians.
The study, published in Health Affairs, enlisted "secret shoppers" to schedule appointments with 743 primary-care providers in five of California's 19 pricing regions. Researchers found that less than a third of patients covered by the state’s two largest insurers were able to schedule appointments with their preferred health care providers.
The findings were consistent among patients enrolled in Covered California plans and those enrolled in private health care companies.
Researchers chose to focus on plans offered by Anthem Blue Cross and Blue Shield of California, as they account for more than half of the individual marketplace.
Anne Donnelly, director of public policy for Project Inform, recently told Patient Daily that incentives and penalties for providers and insurers may improve access to care.
“It could be true, and it could also be true that more consistent monitoring and oversight by the marketplace administrators would be helpful also,” she said.
Participants in the study also reported a significant amount of inaccuracies in health care provider directories. Approximately 10 percent of the time, the listed physician was not affiliated with the practice contacted.
Additionally, in 30 percent of the cases, the wrong
specialty was listed for doctors targeted, and approximately one in five physicians
could not be reached using the phone number listed.
These discrepancies hinder access to health care, researchers emphasized, adding that such issues are not foreign to California.
Blue Shield and Anthem were subjects of a 2014 probe by state officials investigating widespread inaccuracies. The two companies were subsequently fined for failing to maintain accurate directories.
Project Inform is an advocacy group dedicated to improving health and empowering people with HIV by involving them in the process of combating the disease and ending the AIDS pandemic.
“HIV is a little unique, as most already-positive people are moving from the Ryan White system to the marketplace, and most likely getting more assistance (through navigation services provided through Ryan White and through community based organizations) in choosing and getting into a provider – for those seeking biomedical prevention or newly infected, it could be a very different picture,” Donnelly said.
Donnelly believes the access situation could be better in California, in general, than in some other states.
“I know that the inaccuracies in the provider networks have been similar,” she said. “One of the biggest issues for people with HIV or at risk is that it can be hard to identify a provider who has HIV experience, and that is critical for people with HIV.”
Project Inform offers help and counseling to AIDS patients on how to navigate the health care system, according to Donnelly.
“We are a very small organization and my job is policy, but because I have done a lot of training on systems, and I interact with the policymakers in California regularly, I get called a lot about navigation,” Donnelly said. “We do some biomedical prevention navigation also. Mostly, I try to do training for those who specialize in navigation and solve the problems that are very difficult.”
HIV patients also face additional obstacles such as stigma, discrimination, affordability, lack of Medicaid expansion in some states, discriminatory benefit design and difficulty accessing treatments due to prior authorizations, she said.
Organizations in this story
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