Unveiling Ghost Provider Networks for Hawaiʻi Medicaid Members, 2023

Abstract

Provider networks dictate which providers health plan members can see to receive health services. Given this importance, provider networks can act as both facilitators and barriers to members’ access to care. Ghost Networks refer to the portion of the provider network that may be unusable to some or all members. In Hawaiʻi, the extent to which the Medicaid provider network is available to members is unknown. All five health plan provider network files were combined to create a state-wide provider network. Overall, 94.1% of the provider network is open to accepting new members with variation depending on island-rurality location and provider specialty. A significantly smaller proportion of the provider network (75.3%) has actually seen a Medicaid member in the past 12 months. Various factors found to be positively associated with being active and accepting new members include providers offering telehealth to other island-ruralities and number of health plan contracts. Secret shopper calls for primary care and behavioral health providers identified pervasive provider directory inaccuracies and low appointment attainment (14.3%). Over half (55.9%) of provider directory listings may contain inaccuracies presenting another potential barrier to accessing care. These findings have important implications for addressing potential access to care issues for health plan members. Prevalent provider directory inaccuracies, changes in accepting new patients status, and widespread provider inactivity may limit the number of providers to which beneficiaries have access and ultimately impact health care utilization and outcomes.