Mental health patients face few choices on narrow networks in health care marketplace
Patients with mental health issues are much more likely to be corralled into narrow networks when buying health insurance plans on the individual marketplace, a far greater percentage than those seeking primary care, according to a new study.
Under the Affordable Care Act (ACA), exchange plans on average included just 11 percent of mental health care providers in any particular area, the study by the University of Pennsylvania found. This compares to the still low 24 percent of primary care providers.
"This really points to a systemic issue with mental health care services within the networks," Jane Zhu, an associate fellow at the University of Pennsylvania's Leonard Davis Institute and one of the study's authors, said. "It is not just an ACA issue."
But, Zhu told Patient Daily, "narrow network plans are very popular under the ACA," across the board. It is one of the few ways insurance companies can cut costs under the legislation, she said.
The University of Pennsylvania study found that only 43 percent of psychiatrists participate in any networks, with that number dropping to 21 percent for all mental health care specialists.
Ron Honberg, senior policy adviser with the National Alliance on Mental Illness (NAMI), described as "pretty appalling" the fact that plans, on average, include only 11 percent of providers in any given area, way below the recognized narrow network threshold of 25 percent.
"I think that (11 percent figure) is probably correct. You hear constantly from people around the country, but it is a bigger problem in rural areas, " Honberg told Patient Daily. "This has (been) a problem that predates the ACA, a problem in Medicaid/Medicare.
"The ACA has made it worse," Honberg said, adding that the legislation has many good features, not the least of which is the fact that health care plans on the exchanges at least must cover mental health and substance abuse.
Zhu, who authored the study with statistical analyst Yuehan Zhang and Professor Daniel Polsky, identifies one major problem with the ACA: the unclear regulations covering mental health coverage.
"It does not really specify the extent of coverage, only mentioning it should be sufficient," said Zhu, who recognized that the ACA does cover mental health care.
Honberg said one major issue is there is parity of pay for psychiatrists, who are regarded as "poor cousins" within the medical profession.
But Honberg suggested one potential path to a solution: expand the number of mental health professionals other than psychiatrists and change elements of the delivery and manner of services.
There is no substitute for psychiatrists, but often they are needed when delivering care, Honberg argues. He advocates expanded use of advanced practice nurses, psychologists and mental health counsellors. Often these are not covered by plans.