Access to healthcare is a fundamental right for all, regardless of individuals’ socioeconomic status or geographic location.
However, a recent report developed by LexisNexis Risk Solutions provides new insights on national and regional provider density trends for primary and specialty care. The report revealed significant inequities in provider availability across the U.S., highlighting the need for awareness and action. The analysis also examined the frequency of changes in prescriber data, the metropolitan areas experiencing the most changes in the number of primary care providers (PCPs), and the metropolitan areas with the highest and lowest number of heart disease patients per cardiologist.
The analysis showed the top metropolitan areas with the highest and lowest percent change in PCPs between June 2022 and June 2023. The Vallejo-Fairfield, California, area had the highest increase, with a nearly 40% rise in PCPs. On the other hand, Fayetteville, North Carolina, experienced the sharpest decrease, losing almost 12% of its PCPs.
The provider density analysis also compared the number of heart disease patients per cardiologist in different metropolitan areas. Smaller areas had higher patient-to-cardiologist ratios, with rural communities having thousands of patients per cardiologist. Boston had the lowest ratio of 196 heart disease patients per cardiologist while Las Vegas had the highest, 824 heart patients per cardiologist.
In addition, the analysis discovered that prescriber data degraded significantly in a short time. Within 90 days, contact or license information changed for over a quarter of prescribers (26%). This finding was based on the primary location of more than 2 million prescribers and demonstrated the potential for data inaccuracies. These inaccuracies pose an additional challenge for patients navigating the healthcare ecosystem.
Having up-to-date provider data is crucial for meeting patient needs and facilitating healthcare services. Over time, changes in providers’ demographic and license information affect how and where providers practice and the services available to consumers. Some metropolitan areas have seen provider growth and excellent specialist coverage, while others are experiencing shortages.
In an interview with Managed Healthcare Executive, Jonathan Shannon, M.B.A., Associate Vice President of Strategy for the healthcare team at LexisNexis Risk Solutions, emphasized that the current ratios are not solely a result of provider shortages but also due to the influx of people relocating to a particular region. “We know that the population doesn't remain static. There’s the numerator of patients and the denominator of providers, and both of those numbers change over time depending on people's preferences.”
For example, their analysis showed Las Vegas had one of the highest ratios of heart disease patients per cardiologist. Shannon explained this is likely a byproduct of both the influx of new people into the Las Vegas area and provider shortages in that area.
“Generally speaking, as you reach a critical mass of panel size, the level of access to care goes down, potentially affecting the quality of care,” Shannon said. He explained that as the demand for healthcare services increases, there is a potential problem where a single provider or specialist may not be able to accommodate all patients in need, resulting in some patients not seeking care due to limited availability. On the other hand, Shannon said: “if the provider tries to see as many patients as they can, this can lead to physician burnout, which can result in losing a provider or specialist in that particular area entirely.”
The amount of data changes among healthcare providers directly affects consumers trying to navigate the healthcare system, according to Shannon. “Around 26% of prescribers experienced at least one change in their contact or license information in a 90-day period, which is a huge number—that’s one in four prescribers,” Shannon pointed out. “This adds another layer of complexity to an already confusing ecosystem. Approximately 10% of these changes involve address, phone, or fax numbers, making it even more challenging for individuals to access care.”
In response to determining the implications of this type of analysis for managed care organizations, Shannon explained that access to comprehensive data is crucial. “When establishing a new network or entering a particular market, having the necessary data helps determine if the network will meaningfully cater to existing chronic conditions in the market. It also allows for the implementation of ancillary care, such as telehealth capabilities, in areas where coverage may be lacking,” he said.
“Additionally, focusing on preventative measures, like promoting exercise and a healthy diet, especially with heart disease, can help avoid acute conditions that require care with a cardiologist. By implementing these strategies, managed care organizations can effectively reduce acute outcomes, especially in markets with limited provider coverage,” Shannon stated.