J Health Care Poor Underserved. 2022;33(2):597-611. doi: 10.1353/hpu.2022.0050.
We assessed provider directory accuracy and timely access in Maryland's Medicaid managed care program, using annual surveys from the annual random and representative provider surveys conducted on behalf of the Maryland Department of Health for 2018 and 2019. Based on 3,262 calls to 2,002 providers in 2018 and 2,739 calls to 2,033 providers in 2019, we found that provider directories are highly inaccurate. Insurance coverage could only be verified for 46% of the listed providers in 2018 and 56% of the listed providers in 2019. Among providers whose insurance participation was verified, beneficiaries were able to schedule timely general care appointments in 90% of verified providers in 2018 and 85% of verified providers in 2019; slightly more than 70% of appointments were scheduled on the first call. The success rate for urgent care appointments was lower but improved substantially once alternative providers were accounted for. Even for verified providers, timely access standards were often not met, particularly for general care. We also note the substantial variation across managed care organizations and across years. Our findings raise concerns from both an enrollee as well as a broader policy perspective. More oversight and enforcement are necessary to guarantee access to care.
我们评估了马里兰州医疗补助管理式医疗计划中供应商目录的准确性和及时访问情况，使用了 2018 年和 2019 年代表马里兰州卫生部进行的年度随机和代表性供应商调查的年度调查。根据 2018 年对 2002 名供应商的 3262 次呼叫和 2019 年对 2739 名供应商的呼叫，我们发现供应商目录极不准确。2018 年，列出的供应商中只有 46%的保险覆盖范围可以核实，2019 年为 56%。在保险参与得到核实的供应商中，2018 年有 90%的经核实供应商和 2019 年有 85%的经核实供应商可以及时预约常规护理，在 2018 年的首次电话预约中，有超过 70%的预约成功。紧急护理预约的成功率较低，但在考虑替代供应商后，成功率大幅提高。即使是经过核实的供应商，也经常无法满足及时获得护理的标准，尤其是在常规护理方面。我们还注意到，不同管理式医疗组织和不同年份之间存在很大差异。我们的发现引起了参保人和更广泛的政策角度的关注。需要加强监督和执法，以保证获得医疗服务的机会。
