The insurance companies who handle Medicaid in Tennessee have banded together to help patients with the most basic need: finding a doctor who will take their coverage. Medicaid patients often have difficulty locating a physician — in part since the government program pays less than most insurers but also because records are out of date.
Even in an age where information is at people's fingertips, there are entire companies that specialize in services like updating doctors' phone numbers and addresses online. One of those companies, CAQH, is now working with the insurers who administer TennCare, the state's Medicaid program.
Doctors will soon have one central portal to keep their relevant data up to date. TennCare patients should be able to reliably search on the websites of Amerigroup, UnitedHealthcare and BlueCross to find a doctor.
"A critical piece of information is whether the provider is accepting new patients. So all that information needs to be communicated by the provider to the plans quickly and kept current," says Atul Pathiyal, senior vice president with CAQH.
The Washington D.C.-based nonprofit has said it would like to make Tennessee a national model.
Patient advocates say it's been impossible to know if the network of doctors is adequate for Tennessee's low-income population because there has been no accurate system to measure who is really participating. There was an influx of new doctors along with the Affordable Care Act, when rates were raised, but the reimbursement has since fallen.
"The insufficiency of the directories are not just about enrollees having trouble finding real providers but also result in a system that is broken because TennCare and the plans have no way to address the gaps in the system," Tennessee Justice Center executive director Michele Johnson writes in an email.