Oregon Health and Science University – InsuranceNewsNet
July 19, 2022 (NewsRx) — By a
These “ghost” networks undermine access to care for the most needy patients, according to the study published in the July issue of the journal Health Affairs.
“If this represents the state of provider directories more broadly, it’s a huge concern for patients,” the lead author said.
Zhu said the discovery, the first of its kind, highlights an overworked system that too often fails to provide treatment for people with mental disorders.
“Medicaid is a major payer for mental health care in the
The discoveries in
The study cited previous research noting that about half of Medicaid recipients with severe mental illness reported unmet medical needs. The phantom directories described in today’s review compound this problem.
“At least on paper, an assurance plan can point to vendor directories and say, ‘See, we have all these vendors that are part of our network under contract,'” Zhu said. “But if these directories don’t reflect the providers who are actually seeing patients, then what good are they? »
The inability to keep provider directories current and up-to-date may be the result of an administrative burden on medical clinics and insurers, Zhu said. Providers often change locations, retire, or stop taking Medicaid-covered patients. All of this can be difficult to follow.
Additionally, inaccurate provider networks have regulatory implications.
“Many states rely on provider directories to monitor how well a health plan’s provider network facilitates access to care,” Zhu said.
In a related study published in the
Besides administrative shortcomings in accurately monitoring access to providers, Zhu said the fact is that the country’s mental health care delivery system is severely constrained.
“We just need more mental health professionals to meet the demand,” she said.
In addition to Zhu, the co-authors of the study published in Health Affairs include
The study published in the journal Health Affairs was supported by the
(Our reports provide factual information on research and discoveries from around the world.)