TP493: Ghost Networks and the Reflex to Automate

Chris Boyer and Reed Smith bring in two people who worked the problem from the inside. Chris Hemphill of Modular Feedback, who builds AI for a living, and Heather Nairn, a healthcare economist who reads this as an access problem first. The reflex across the industry is to point AI at the mess. Standardize the data, set some agents loose, let the model sort it out. Hemphill and Nairn tested that reflex against a plain deterministic workflow on exactly this job. The workflow won on accuracy, on speed and on cost. Their point is not that AI is useless here. It is that the most useful skill in this work is knowing when not to reach for it. The deeper problem is structural. Provider data is a commodity. Every payer and every health system chases the same handful of fields, guards its copy as proprietary, and rebuilds the same record in parallel. Every cycle spent on that is a cycle not spent on the access work that moves outcomes. Transportation, care coordination, the patient in crisis who just needs a number that connects. Mentions from the Show: U.S. Senate Finance Committee, Ghost Network Secret Shopper Study, May 2023: https://www.finance.senate.gov/imo/media/doc/050323%20Ghost%20Network%20Hearing%20-%20Secret%20Shopper%20Study%20Report.pdf HHS Office of Inspector General, behavioral health network issue brief, October 2025 (72% of listed clinicians non-participating) New York Attorney General, "Inaccurate and Inadequate: Health Plans' Mental Health Provider Directories" (EmblemHealth investigation) American Psychiatric Association class-action complaint against EmblemHealth, January 2026: https://psychiatryonline.org/doi/full/10.1176/appi.pn.2026.03.3.15 CMS Final Rule CMS-4208-F2, finalized September 2025 (MA directory data to Medicare Plan Finder by plan year 2027; 85% accuracy threshold) Ideon, CMS Provider Directory Requirements compliance guide, March 2026 (48.74% of MA provider locations carry at least one inaccuracy): https://ideonapi.com/resources/blog/cms-provider-directory-requirements-a-complete-compliance-guide-for-2026-2027/ JAMA, AI-assisted directory inconsistency study, University of Colorado researchers (81% of physicians show inconsistencies), via Healthcare Dive: https://www.healthcaredive.com/news/inconsistent-physician-directories-no-surprises-act/645307/ Modular Feedback (Chris Hemphill), deployment write-up: https://modularfeedback.com/blog Chris Hemphill on LinkedIn: https://www.linkedin.com/in/chris-hemphill-b278009/ Heather Nairn on LinkedIn: https://www.linkedin.com/in/heather-nairn-2114b354/ Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Learn more about your ad choices. Visit megaphone.fm/adchoices