Oregon Health and Science University – InsuranceNewsNet

July 19, 2022 (NewsRx) — By a News Reporter – Staff News Editor at Daily Insurance News — Amid an increase in the demand for mental health care, a new report from researchers at Oregon Health and Science University finds that nearly six out of 10 network providers listed in Oregon’s Medicaid provider directories are not actually available to see patients.

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. Jane M. ZhuMD, Assistant Professor of Medicine (General Internal Medicine and Geriatrics) at OHSU School of Medicine. “If the majority of providers aren’t actually accessible, it leads to delays and disruptions to the care and treatment people need.”

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 WEwith enrollees disproportionately likely to have severe and persistent mental disorders, as well as complex social and medical needs that exacerbate barriers to care,” the authors write.

The discoveries in Oregon may be relevant across the country.

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 American Journal of Managed Care, Zhu and co-authors found a range of network adequacy standards among state Medicaid programs and little enforcement of these standards across states. While 28 states had separate time-and-distance standards defined for mental and behavioral health care, only one-third of Medicaid programs – 14 states – published separate access standards for the treatment of alcohol-related disorders. substance use.

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.

President Joe Biden highlighted what he defines as a national mental health crisis during his State of the Union address in March.

In addition to Zhu, the co-authors of the study published in Health Affairs include Christina J. Charlesworth and K. John McConnell from OHSU and Daniel Polsky of Johns Hopkins University in Baltimore.

The study published in the journal Health Affairs was supported by the National Institute of Mental Health of the National Institutes of Healthprice 1K08MH123624.

(Our reports provide factual information on research and discoveries from around the world.)

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