The Impact of Provider Data on America’s Mental Health Crisis

In a recent webinar I conducted with leaders at Elevance Health, we discussed how technology can transform the management of provider data by fixing errors at scale. However, we must never get so focused on the technology or business operations that we forget the real impact these data errors have on patients. 

Today, patients spend hours calling doctors only to discover they are not practicing at the listed locations or that their phone numbers are no longer in service. When patients are finally able to connect with a provider, they discover that practices are frequently not accepting new patients. Then, if patients do find a provider and receive care, they may encounter that the doctor isn’t actually in-network and end up with a surprise medical bill. This reality creates barriers to patients accessing care, and when illnesses go untreated, patients suffer. In the United States, studies have shown that there is a patient population ghost networks are significantly impacting: patients suffering from mental health conditions. 

In a 2015 study, investigators identifying themselves as patients could only make appointments with 26% of the psychiatrists they called. 

In February 2022, The Washington Post published a story in which a parent described calling 73 mental health providers for her daughter, yet not one was available within two months for a consult. Doctors listed on their health insurance’s provider directory had either retired, were not actually considered in-network, had disconnected phone lines, or had died. 

Another study published in May 2023 by the Senate Finance Committee discovered secret shoppers could only make appointments with 18% of the mental health providers they called. 

The risk of this problem is best captured by Heidi Strunk, CEO of Mental Health America of California, who said, 'For some individuals who are barely holding on, one call is all they have.' Patients give up, and a recent study found that a staggering two out of three patients diagnosed with mental health illnesses are not able to access care. 

As a physician, this is beyond disheartening. However, there are things in our control that can help solve this issue, and the help of AI can be enormous. I am not talking about using AI to treat or triage patients. We are a long way from trusting AI to be involved in patient care, and I would argue that behavioral health is an area where the human element is especially critical. However, we have found that AI is highly effective in identifying and eliminating ghost networks. 

This blog has previously discussed how health plans can use AI solutions to improve provider directory accuracy and build trust in those solutions. The results are powerful. At HiLabs, we have been able to help health plans significantly improve their directory accuracy. In one case, a national health plan’s directory accuracy improved from 65% to over 95%. The BBC also featured HiLabs in their 'Human Component' series, recognizing the profound impact of our technology on patient lives. 

We can’t snap our fingers and magically create more mental health providers. And sadly, most of us can’t help patients make that first call. But we can be ready to respond when they do. This is one of the exciting opportunities where AI can help patients today, giving me enormous hope for future innovations. 

Dr. Neel Butala is an Assistant Professor at the University of Colorado School of Medicine, Co-founder, and Chief Medical Officer of HiLabs.