Research Collaboration Targets Ghost Networks
HiLabs, Inc. and Dr. Thomas Tsai from the Harvard T.H. Chan School of Public Health and Harvard Medical School have announced a multi-year research collaboration to study provider network adequacy and ghost networks in Medicare Advantage. The partnership aims to measure real-world access to care for 35 million Medicare Advantage enrollees, addressing a critical gap in healthcare delivery.
What Are Ghost Networks?
Ghost networks occur when provider directories list physicians who are unreachable, no longer participating in a plan, or not accepting new patients. This problem affects millions of beneficiaries, turning what appears to be a comprehensive network into a barrier to care. For older adults and people with long-term disabilities, a ghost provider is not an inconvenience but a significant obstacle to receiving necessary medical attention.
HiLabs' Role and Technology
HiLabs, a healthcare data intelligence company, provides the MCheck® Provider suite, which processes hundreds of millions of provider records and continuously validates provider availability across thousands of data sources. Five of the nation's ten largest health plans and dozens of regional carriers use this technology to move beyond paper compliance and understand their network's actual delivery capabilities in real time. A leading national behavioral health plan recently selected HiLabs to achieve true network adequacy across its network, demonstrating the operational impact of this approach at scale.
Federal Scrutiny and Research Goals
Medicare Advantage network adequacy is under intensifying federal scrutiny. CMS audits increasingly focus on the gap between what provider directories list and what members can actually access. This collaboration will examine how ghost networks affect access to care, evaluate how practitioners measure and experience network adequacy, and assess the gap between listed and accessible providers for patient outcomes.
“As more Medicare beneficiaries elect to enroll in Medicare Advantage, federal policymakers should evaluate whether beneficiaries can access a diverse array of high-quality physicians, hospitals, and other healthcare facilities necessary to achieve optimal health outcomes,” said Dr. Thomas Tsai. “This collaboration will allow the Healthcare Quality and Outcomes Lab to conduct cutting-edge research to ensure Medicare beneficiaries are able to access the care they need under private Medicare Advantage health plans.”
Impact on Patients
For 35 million Americans enrolled in Medicare Advantage, finding a doctor should not be the hardest part of getting care. Yet for millions, provider directories that look complete on paper mask a different reality. This research aims to bring scientific rigor to measuring the problem at a national scale for the first time, contributing real-world provider data and AI-powered ghost network detection to help independent researchers close the gap.
