It’s time to rethink – and prioritize – provider data’s role in solving care access challenges

Delivering effective health care means having accessible and up-to-date physician information. Recent events, such as the COVID-19 pandemic, industry consolidation, and clinician burnout, intensified inequalities in care accessibility nationwide. It is fundamentally important for health care organizations to fully understand the status of physicians in their respective markets to align care with patient needs.

A new data brief analyzes recent provider density trends for primary and cardiology care both nationally and regionally, evaluating the frequency of prescriber data changes, urban areas observing a significant change in primary care provider (PCP) numbers, and metropolitan areas associated with the highest and lowest density of heart disease patients per cardiologist.

Provider density and coverage ratios

The concentration of PCPs directly influences a community’s capacity to provide accessible and efficient care. This impact is particularly acute in rural areas with less financial and infrastructural resources. Significant discrepancies are vividly apparent across the country, with some areas exhibiting PCP growth while others are experiencing an outflow. For example, Vallejo-Fairfield, California, an affluent area with a median household income of nearly $90,000, saw a 40% increase in PCPs between June 2022 and June 2023. By contrast, the Fayetteville, North Carolina, area, where median household income is just more than $53,000, saw the highest decrease in PCPs, with a reduction of almost 12% in the same period. These numbers have implications beyond statistics, emphasizing the connection between uneven clinician distribution and inequitable access to care. For providers, limited resources result in fatigue and high turnover. Patients face a limited supply of available appointments and a heightened risk of missing important preventative care services.

Furthermore, specialties such as cardiology have seen similar discrepancies in coverage quotas. Despite one person dying every 33 seconds from cardiovascular disease in the United States, there are still astonishing levels of inequity in regional cardiologist availability. Metropolitan statistical areas (MSAs) with well-recognized academic hospitals and health systems routinely supply optimal cardiology care in all MSA sizes. As MSAs reduce in scale, the ratio of patients per cardiologist noticeably increases, potentially impacting the quality of care, patient satisfaction, and burnout.

Health care organizations have a responsibility to ensure patients are aware of provider concentration and accessibility; this will inform care decisions, expectations of clinical quality, and patient experience. In MSAs with fewer physicians, for example, patients may not be aware that a neighboring community has more available appointments, and even if they are aware, they may lack transportation to travel there. This strains the patient experience and can lead to care deferral. When physician population data is readily available, patients in underserved areas discover previously unseen care options. They can also inform community and health care organizations about connecting patients to necessary resources, such as transportation.

Importance of data accuracy

Managing provider data is more complicated than it may seem. In a sample of more than 2 million prescribers, 26% had at least one change in their contact or license information within a 90 day-period, highlighting the urgency of frequent data verification. Additionally, 9% of prescribing physicians had changes in addresses and phone or fax numbers, and 19% of prescribers had a change in license expiration date or status. Given that this data is constantly evolving, it is crucial to continuously monitor demographic shifts to connect patients with the correct care teams to meet ever-changing patient demands.

Clinicians, health plans, managed care organizations (MCOs), and other care delivery entities must supplement their internal data efforts because dynamics shift over time. PCP referral networks diverting patients to a specific hospital or health system for specialty care may no longer exist. This has a noticeable impact on patient revenue and touchpoints. If there is a massive outflow of PCPs, patients will face further difficulties finding their way to a trustworthy health system, which may generate adverse outcomes because of treatment delays. Quality scores, reimbursement rates, and patient outcomes will drastically decrease because hospitals will receive an influx of acute cases without a robust network of physicians to support the community's needs.

A way forward

With approximately 133 million people in the United States navigating chronic conditions and sometimes comorbidities, patient demands will continue to rise. To prevent physician burnout, it is important to thoroughly comprehend the relationship between the supply and demand quotient.

Information is power. With accurate and actionable data, health care organizations can understand if the population has a higher demand for care vs. the supply and look at novel ways to deploy care in that market, like a tiered model or stratified network of retail health clinics, urgent care facilities, and telehealth platforms that boost convenience. For example, Kaiser partnered with CVS MinuteClinic to provide urgent care to patients who live in areas without Kaiser Permanente doctors. The key is increasing the supply of treatment capabilities while allowing physicians and other clinicians to operate at the top of their licenses.

To support diverse patient needs and minimize adverse outcomes, health care organizations must devise an impactful methodology to consistently track shifts in the clinician population.

Jonathan Shannon is the associate vice president of healthcare strategy and innovation at LexisNexis Risk Solutions, a data company that provides reliable and digestible data to health care companies to help them make informed decisions and advance care delivery.