Members Find Private Payer Mental Healthcare Networks Inadequate

Private health plan members have found that payers’ mental healthcare networks are less adequate than their medical health networks, a study published in the JAMA Network Open revealed.

There are many deficiencies in the national mental health network, largely influenced by the mental healthcare workforce shortage. 

“In practice, primary care practitioners may address deficiencies in provider networks in several ways,” the researchers explained. 

“They may prescribe medication for patients with mild to moderate symptoms while working collaboratively with a therapist who provides counseling, they serve as a trusted referral source and provide initial treatment while helping patients locate a specialist, or they may prescribe medication out of necessity if a patient is unable to find a specialist.”

The study analyzed member ratings related to provider network adequacy, tracked the rate of practitioners leaving members’ networks in a three year timeframe, and assessed how provider network participation impacted members’ health plan selection process.

The researchers used data from a 2018 national internet survey of private insurance health plan members. Over 19,600 individuals participated in the survey with a 66 percent completion rate.

Demographically, nearly four in ten participants were between the ages of 18 and 34. Six in ten respondents identified as women, 17 percent were Hispanic individuals, and 17 percent were non-Hispanic non-White individuals. Two-thirds of the respondents were non-Hispanic White individuals.

A provider’s in-network status could influence members’ health plan choices. Overall, almost four in ten participants stated that a provider’s in-network status impacted their decision. However, for those with more immediate mental healthcare needs, the network status of a particular mental healthcare provider did not seem to have as much influence.

The researchers suggested that the small share of members who checked mental healthcare or specialty care providers’ network statuses may indicate that network construction is not extremely influential in health plan selection.

Out of the participants who had more than one health plan option, the same share of participants checked for a mental healthcare provider’s in-network status and a specialist’s in-network status when selecting a health plan. However, more participants checked for the in-network status of their primary care provider (45 percent).

In the network adequacy analysis, more respondents found that their mental health network’s adequacy was not as satisfactory as their medical health network’s adequacy. This did not change significantly for members who only received mental healthcare through their primary care providers nor did it differ significantly from those who solely received in-network care.

One out of every five members reported that at least one provider left their network within the past three years. Mental healthcare professionals and primary care providers were equally likely to leave their networks, according to the participants. 

Seven out of ten participants switched providers when their primary care provider left the network. Around four out of ten participants switched providers when a mental healthcare provider left their network and approximately the same share of participants changed providers when their specialty provider left.

Previous studies indicated that members might pay more in order to have access to broader networks and maintain their current provider. This was particularly true of patients with poorer health conditions.

However, the JAMA Network Open study aligns with separate Avalere research that discovered low network adequacy for behavioral healthcare among health plans. Regional health plans were particularly complicit in evading regulations for behavioral healthcare network adequacy.

Experts on mental and behavioral healthcare parity have urged employers to lobby their payers for certain data points in order to assess payers’ network adequacy and overall parity. Employers should compare payers’ network directories to their claims to see if the network is providing the right kind of care and eliminate providers who are not seeing high claims rates.