Dr. Jane Zhu is an Assistant Professor of Medicine at Oregon Health & Science University (OHSU) School of Medicine. Zhu is the lead author of a new OHSU study on the Oregon Medicaid Mental Health Provider Directories, which found that 6 of the 10 network providers listed are not actually available to see patients.
These “ghost” networks compromise access to care for patients who need it most, according to the study. Zhu discusses some possible reasons for directory inaccuracies and how they affect people seeking care in this Q&A.
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State of the reform: Can you tell us about some of the team’s motivations for conducting the study?
Jane Zhu: “I am a primary care physician and de facto mental health provider. When I refer my patients to specialized mental health care, I see how difficult it is for them to find a provider.
Suppliers are over capacity, they are changing affiliations or there are errors in contact details. We therefore sought to find out to what extent the directories of suppliers—which are lists of all providers with whom an insurer contracts to provide care to its members—reflect mental health care providers who actually see patients.
My research also showed that provider networks for mental health care tend to be tighter than for other medical care. And that there is a lot of variation in how states monitor network adequacy [in the Medicaid program].”
OR: Patients already struggle to access mental health care. How does this exacerbate this problem?
JZ: “Patients often use provider directories to find their clinician. In mental health care, there is already a shortage of providers, low provider uptake in the Medicaid program, high provider turnover, and high demand for services.
So patients already face an uphill battle to get mental health care. Add to those vendor directories that don’t actually reflect who is available and active. Rather than having a frictionless downward path to care that gets people with mental health issues where they need to go, patients face layer upon layer of barriers to access.
OR: Can you discuss some possible reasons why these directories are not accurate? What can be done to correct the problem?
JZ: “First, it appears that a small group of mental health providers provide the bulk of Medicaid patient care, in addition to an already small number of mental health providers overall. A number of others studies have also found this.Because care is focused on a small group of providers, it can be difficult for insurers to meet network adequacy requirements on paper, which can be an incentive to include more providers. . [in-network] who may actually have the ability or desire to see patients.
Second, updating and verifying provider networks is labor intensive for both insurers and providers. Clinicians move, downsize their panel, take time off, complete training, etc., and it’s a huge administrative burden for insurers to be able to track that.
Providers themselves contract with multiple payers, so tracking directory requests from providers also takes a lot of time and effort. As it stands, there are no standardized, streamlined, and painless processes for this information to be collected, verified, and distributed. »
OR: Besides updating these directories to reflect accurate information, what other kinds of initiatives could help Oregonians get better access to mental health care?
JZ: “Long term, we just need more mental health care providers, both in Medicaid and in all types of payers. We therefore need to address the retention and recruitment of mental health service providers who currently cannot meet the mental health needs of the population. This means paying attention to provider reimbursement, administrative burdens, training and education pathways, and reducing burnout and attrition. And ensure that we invest in mental health service delivery systems and give mental health care the attention it deserves.
The states’ short-term Medicaid programs are all trying to set their standards for network adequacy. Network adequacy seems to be a fairly intuitive concept. We want to make sure people get the care they need when they need it. But in reality, it has been very nebulous and difficult to operationalize.
Thus, the first implication is that relying on vendor directories to assess network suitability is flawed. It may be better to use a combination of data and methods– including complaints data and patient surveys – to offer meaningful metrics on what constitutes an adequate network.
This Q&A has been edited for clarity and length.