New York Health Plan Association analyzed over 300 behavioral health providers across multiple health plans. Find out what was revealed about their network.
Ensuring accurate provider directories remains a critical, yet daunting task for health plans. "Ghost networks," or provider listings that appear in directories but offer no real availability to patients, continue to plague the industry, particularly within behavioral health.
Leap Orbit recently partnered with the New York Health Plan Association (NYHPA) to address this widespread challenge. Prompted by a significant report from the New York Attorney General detailing inaccuracies and inadequacies within provider directories—especially concerning mental health services—NYHPA conducted an audit of their networks. Together, we co-hosted the webinar "Busting the Ghost Provider Problem: Solutions for Now and the Long Term," highlighting Leap Orbit’s innovative Convergent platform, designed specifically to tackle these network inaccuracies.
Ghost providers aren’t just inconvenient; they cause significant regulatory, financial, and operational risks, diminishing patient trust and satisfaction. Behavioral health services are especially vulnerable, with studies showing nearly half of listed mental health providers are unreachable or unavailable for new patient appointments. According to a recent NBC investigation, this phenomenon severely impacts patient access, exacerbating mental health crises and leading to potential violations of mental health parity laws.
Providers themselves face considerable administrative burden and "abrasion," repeatedly asked for attestations and credentialing updates. This tedious cycle often results in further inaccuracies and incomplete data, perpetuating the cycle of ghost networks.
In our case study with NYHPA, Leap Orbit deployed Convergent—our AI-driven provider data management platform—to analyze over 400 behavioral health providers across New York state. Here's how we tackled it:
Our findings were striking: 46% of providers (191 out of 412 analyzed) were identified as ghost providers. The Convergent algorithm delivered a remarkable 93% accuracy rate, verified through manual validation.
By identifying and eliminating ghost providers, Leap Orbit’s Convergent platform helps health plans:
Addressing ghost networks demands a collaborative, systematic approach. Initiatives like Illinois' standardized provider roster submission demonstrate the effectiveness of coordinated statewide solutions. Leap Orbit remains dedicated to helping health plans navigate these complexities with efficient, technology-driven strategies.
Ready to end your provider data management nightmares?