Coverage and Providers Are Only the Beginning
Episode 2
Indiana has physicians, coverage programs and a growing set of access investments. The path from recognizing a need to completing care still requires finding a reachable provider, securing a timely appointment, understanding the cost and getting there. Indiana’s data shows where that path holds and where it breaks down.
Episode 1 established that Indiana’s population is not simply growing. It is aging in every county, shifting geographically, and becoming more diverse. Those changes alter what health services Hoosiers need, where they need them, and whether the system they encounter is accessible. This episode follows the healthcare journey between needing healthcare and receiving it.
The journey requires recognition of need, insurance coverage, a provider who accepts that coverage, an appointment available within a reasonable timeframe, an understanding of what the care will cost, and a practical way to get to the provider. That distinction matters because healthcare organizations usually only see the part of the journey that reaches them. A provider sees the scheduled visit. A health plan sees the claim. A community organization sees the residents who need help finding transportation or affording care. None of those views capture the entire path.
From Workforce to Reachable Care
Indiana has a sizable healthcare workforce. The Bowen Center identified 19,789 physicians and 81,982 registered nurses actively practicing in Indiana or providing telehealth to Hoosiers in 2025. The physician workforce alone included 6,783 primary care physicians and 868 psychiatrists. Its 2024 reports also identified 6,142 pharmacists, 2,532 dentists, 3,825 dental hygienists and 1,501 psychologists.
The challenge is where that capacity is available and whether a resident can reach it. Physicians practiced in 91 of Indiana’s 92 counties, but 33 counties exceeded 3,500 residents per primary care physician, a federal shortage-area threshold referenced in the Bowen report, while 37 counties reported no psychiatrist capacity. The pharmacist report showed a similarly wide range, with Ohio County reporting no pharmacist capacity. Those county measures are important signals, but they are not the same as access. A Hoosier may receive care from a provider in a neighboring county or through telehealth, making the relevant question not simply whether capacity exists within the county, but whether it is reachable when care is needed.
A Provider Directory Is Not Care
A nearby provider may not participate in the resident’s network, accept the specific insurance product or have an open panel. A directory may include a provider who has moved, retired or left the network. And even when a usable provider is found, the next available appointment may be weeks or months away or the travel time to reach it may be prohibitive.
Indiana’s Medicaid program offers one limited example of the gap between a provider listing and an appointment. According to the 2025 External Quality Review Organization (EQRO) Technical Report, secret shopper testing of selected primary care and obstetric scenarios found that more than half of the tested program and scenario combinations produced an appointment less than half the time.
An in-network provider listed in a directory may meet a network standard, but that does not necessarily mean the resident can obtain care. If the provider is unreachable, unavailable or cannot offer a timely appointment, the network may look more accessible on paper than it is in practice.
Indiana Provider Capacity Explorer
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When Coverage Is Not Enough
Cost, including copayments, deductibles and coinsurance, can stop the process before or after an appointment is scheduled. In a 2022 survey of 1,249 Indiana adults, 56% reported delaying or going without healthcare because of cost. Among respondents with private insurance, 53% reported the same. Thirty percent reported rationing medication or not filling a prescription, and 26% skipped a recommended test or treatment. While the survey is now several years old, it illustrates an important distinction in the access journey. Having coverage does not necessarily mean a Hoosier can afford to use it.
When care occurs without an affordable payment path, the access problem can become medical debt. According to the Indiana Community Action Poverty Institute, approximately 16% to 20% of Hoosier families had medical debt in collections, totaling over $2.2 billion statewide as of 2022.
When roadblocks interrupt the healthcare journey, the effects can appear elsewhere in the healthcare system. In 2023, Indiana recorded 170.3 potentially avoidable emergency department visits per 1,000 Medicare beneficiaries age 65 and older and 154.7 per 1,000 employer-covered adults ages 18 to 64, both above the corresponding national benchmarks of 155.2 and 151.4, respectively.
Although not every potentially avoidable emergency department visit results from an access barrier, gaps in provider availability, timely appointments, transportation, affordability, referral completion or follow-up can leave healthcare needs unmet until a resident seeks care in a more intensive and expensive setting.
Indiana Is Investing in Better Access
Indiana is not starting from zero. It is investing in expanding and attracting the healthcare workforce. The state’s Graduate Medical Education Board funds new and expanded physician residency positions, while providers like Franciscan Health are making their own investments in the pipeline with a new osteopathic medical school in Crown Point.
The state-run Indiana Health Prices portal uses the All-Payer Claims Database to help residents compare cost and quality for hospital, outpatient, laboratory and prescription services. Hospitals, including IU Health and Ascension, also offer online and requested estimates, giving residents cost information before deciding where to seek care.
Other responses address specific gaps in the access chain. Fishers Health Department offers free mental-health navigation including provider identification, referrals, warm handoffs and follow-up. HealthLinc brings medical, dental, behavioral health and affordability support together at its northern Indiana clinics.
Policy is also addressing whether networks work as represented. Federal rules require regular provider directory updates and generally protect members from out-of-network costs when inaccurate network information leads them to an out-of-network provider. Indiana added another affordability protection in 2026 when House Enrolled Act 1271 required hospitals to disclose available payment-assistance programs and make a reasonable effort to notify patients about them before beginning collection activity.
These efforts address different parts of the healthcare journey. For Finance, the next step is understanding where the remaining gaps are and what role the organization should play in addressing them.
What Finance Can Do Differently
With continued margin pressure and the shift toward value-based care, this is a good time for Indiana healthcare organizations to think differently about access. When organizations are increasingly responsible for quality, utilization and total cost of care, an appointment that never happens can become more than an access issue.
Most Indiana healthcare organizations already have the data needed to measure where the access journey breaks down. Quality teams may track care gaps and follow-up. Operations may track appointments, no-shows and cancellations. Network teams monitor provider participation and directory accuracy. Finance tracks revenue and cost. Finance is well positioned to connect those streams into one view of where available access stops converting into completed care and what that gap costs the organization. It can apply the same discipline used in the revenue cycle to a part of the care journey that many organizations have not measured in those terms.
The data to answer those questions already exist. Tracing utilization backward from emergency department visits to prior care history, comparing network adequacy reporting against actual appointment availability and completion, and using Community Health Needs Assessment findings alongside claims data can help Finance identify where access barriers may warrant investment and, when investments are made, whether they are removing the barriers they were designed to address.
Where a Hoosier lives can make each step in that journey easier or harder. In rural Indiana, geography can compound the access barriers examined in this episode. Episode 3 will examine why rural access is more difficult and more expensive, what is closing and what is holding on, and what the financial structure of rural care means for organizations and for the Hoosiers who depend on them.
Sources
Bowen Center for Health Workforce Research and Policy. 2025 Indiana Physician Workforce Data Report. Period: 2025 physician license renewal cycle; published 2026.
Bowen Center for Health Workforce Research and Policy. 2025 Indiana Registered Nurse Workforce Data Report. Period: 2025 registered nurse license renewal cycle; published 2026.
Bowen Center for Health Workforce Research and Policy. 2024 Indiana Oral Health Workforce Data Report. Period: 2024 oral health professional license renewal cycle; published 2025.
Bowen Center for Health Workforce Research and Policy. 2024 Indiana Pharmacist Workforce Data Report. Period: 2024 pharmacist license renewal cycle; published 2026.
Bowen Center for Health Workforce Research and Policy. 2024 Indiana Psychologist Workforce Data Report. Period: 2024 psychologist license renewal cycle; published 2025.
Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning. 2025 Annual External Quality Review Technical Report. Period: 2024 secret shopper and network validation activity; report published March 2026.
Altarum Healthcare Value Hub. Indiana Residents Struggle to Afford High Healthcare Costs. Period: Survey of 1,249 Indiana adults fielded October 6 through 11, 2022; brief published January 2023.
Indiana Community Action Poverty Institute, Grassroots Maternal and Child Health Initiative and Prosperity Indiana. Medical Debt in Indiana. Period: Estimates reported for 2022.
The Commonwealth Fund. 2025 State Scorecard on Health System Performance: Indiana. Period: Potentially avoidable emergency department visit measures reported for 2023.
