PORTLAND, Ore. (KOIN) — In a study published Tuesday, researchers from OHSU found that nearly six out of 10 in-network providers listed under Oregon Medicaid provider directories aren’t available to see patients with mental health needs.
The study’s lead author, Dr. Jane M. Zhu, assistant professor of medicine at OHSU, said that these phantom networks undermine access to care for patients that are most in need.
“If this represents the state of provider directories more broadly, that’s a huge concern for patients,” Zhu said. “If the majority of providers are not actually accessible, it leads to delays and interruptions in care and treatment that people need.”
According to the study, the findings reveal a system that is overwhelmed and is often failing to provide treatment for people suffering from mental health conditions.
“Medicaid is a major payer for mental health care in the U.S., with enrollees disproportionately likely to have severe and persistent mental disorders, as well as complex social and medical needs that exacerbate barriers to care,” the study states.
Zhu believes the findings in Oregon may be relevant throughout the country, as about half of Medicaid beneficiaries with serious mental illnesses report unmet medical needs.
“At least on paper, an insurance plan can point to provider directories and say, ‘See, we have all these providers who are part of our contracted network,’” Zhu said. “But if these directories don’t reflect the providers who are truly seeing patients, then what good are they?”
According to Zhu, the failure to maintain updated and accurate directories could be a result of the administrative burden medical clinics and insurers are facing.
“Many states rely on provider directories to monitor how well a health plan’s provider network facilitates access to care,” Zhu said.
Zhu, along with multiple co-authors in a related study, discovered a range of network adequacy standards in state Medicaid programs, as well as little enforcement of these standards across states. The study found that 28 states had distinct time and distance standards defined for mental and behavioral health, but only 14 states — which represent a third of Medicaid programs — published separate access standards for the treatment of substance use disorder.
“We simply need more mental health professionals to meet the demand,” she said.
In addition to Zhu, co-authors of the study published Monday include Christina J. Charlesworth and K. John McConnell of OHSU and Daniel Polsky of Johns Hopkins University.