A close friend of mine was injured in a traumatic incident on his way to work in midtown Manhattan. He needed help. He tried to find a therapist. The search was so difficult that he gave up. He didn't try again for seven years. And during that time, he suffered deeply. This is why I founded Octave. No one should have to struggle alone for years. We should make it as easy as possible for people to find a great therapist. But ghost networks, or directories where most of the therapists aren’t actually available, stand in the way. They give the illusion of support, but leave people stranded instead. Ghost networks have been a known problem for years. It’s been shrugged off as an unrepairable repercussion of the system. That's finally changing. Recently New York's AG announced a $2.5M settlement with Emblem Health after finding 80% of their listed mental health providers were effectively unavailable. Eighty percent!! The fines are coming and the compliance clock ticks on. Fixing the infrastructure can get rid of ghost networks for good. Directories are static. Provider availability isn't. A clinician's schedule can go from wide open to full in under a week. No health plan wants to mislead their patients. They just lack the technology to keep up. The fix exists. Real-time scheduling APIs can turn a static directory into a live one. Several plans are already doing it. Beth Jacobson and I wrote about what's driving this shift and what plans can actually do about it in Becker's Healthcare. Link in the comments.
Sandeep Acharya (he/his), this resonates deeply. The story of your friend giving up for seven years is the part that stays with me. It is a stark reminder that there are people behind every data point, and a directory that looks complete but is not actionable fails them when they are most vulnerable. As someone who has spent years architecting enterprise infrastructure and compliance strategies, this reads like a classic case of static systems failing real-time operational reality. The fix is not incremental. It is architectural. Real-time API orchestration, strong data governance, and continuous verification baked into the system rather than bolted on after the fact. Especially now that the REAL Act is making directory accuracy a federally mandated, publicly scored obligation, treating this like a quarterly project is no longer an option. Great piece. Curious whether you and Beth see the next wave of pressure coming from state AGs, CMS accuracy scoring, or member-led litigation.
Raise your hand if you've been personally impacted by ghost networks: 🙋♀️ A few of years ago when I was trying to find a therapist, I couldn't believe how many numbers I ended up calling directed me to everywhere but a Californian therapist's office. But I sure did reach clinics in Minnesota, Ohio, North Dakota... you name it. So glad something is being done about this!
Ghost networks are the supply-side version of a problem that shows up on the demand side too. Facilities that appear reachable but can't actually convert the call into an admission. The illusion of access costs people in both directions. Seven years is a long time to wait because the infrastructure made it look like help existed.
The problem is insane but excited about the way you and Beth are sharing the roadmap for actually changing it.
Wow, 80%. I'm still processing that. How many people reached out for help and ran into a dead-end? It's heartbreaking and truly unacceptable. So grateful for the work you are doing to push this conversation - and possible solutions - forward.
80% is wild!
Thank you Sandeep for sharing this moving story about the very real negative impact ghost networks have on people. I appreciate co-authoring this piece with you. With accelerating legal pressure, it's so important to raise awareness about the solutions that exist to fix this problem.
https://www.beckerspayer.com/payer/recent-legislation-has-changed-ghost-networks-from-headline-risk-to-a-big-real-liability-here-is-what-to-do-about-it/