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Study Highlights Disparities in Access to In-Network Mental Health Care vs Medical Care

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While health plans often employ reimbursement rates as a tool to incentivize provider participation within their networks, study results showed reimbursement rates for office visits with medical/surgical clinicians were on average 22% higher than behavioral health clinicians.

A new study conducted by health economists at RTI International revealed a significant gap in access to in-network mental health and substance use disorder treatment compared with medical care. For mental health care, patients are 3.5 times more likely to seek out-of-network care for behavioral health services.1

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“The finding of large disparities for out-of-network use and reimbursement rates highlights that health plans are not using the same measures to improve the adequacy of their behavioral health provider networks as they do for medical networks,” lead author Tami L. Mark, PhD, MBA, distinguished fellow and director of Behavioral Health Financing and Quality Measurement at RTI, said in a statement.2 “Our findings echo recent surveys and secret shopper studies that show much greater dissatisfaction with, and lower access to, behavioral health providers than medical/surgical providers.”

The investigation sheds light on the persistent challenges faced by individuals seeking affordable mental health and substance use disorder treatment in the US. The key findings exhibit a significant discrepancy in out-of-network utilization for behavioral health services compared with medical and surgical care.

The investigators found patients to be 3.5 times more likely to seek out-of-network care for behavioral health clinicians, 8.9 times more likely for psychiatrists, and 10.6 times more likely for psychologists. These data demonstrate a substantial increase in out-of-network visits for both acute and sub-acute behavioral inpatient care.

One notable aspect highlighted in the study was the variance in reimbursement rates for in-network office visits. While health plans often employ reimbursement rates as a tool to incentivize provider participation within their networks, the results showed reimbursement rates for office visits with medical/surgical clinicians were on average 22% higher.

When examining the 75th and 95th percentile, those rates jump to 48% and 70%, respectively, reflecting steep increases for in-network reimbursement when compared with behavioral health specialists. Additionally, when compared with psychiatrists, physician assistants were reimbursed on average 19% more, and 23% more when compared with psychologists.

Drawing on claims and enrollment data from over 22 million individuals between 2019 and 2021, the study refutes the notion that high out-of-network utilization for mental health and substance use treatment stems from a shortage of behavioral health providers. Henry Harbin, MD, senior advisor to The Bowman Family Foundation, noted that if provider scarcity were the primary factor, similar disparities would be observed for primary care physicians, which is not the case according to federal workforce shortage data.

“Lack of access to affordable and effective care for mental health is at crisis levels in the US,” Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, said in a statement. “This research demonstrates the profound need for employers and purchasers to demand more of their health insurance carriers to ensure they are providing truly equitable access to behavioral health care in compliance with parity requirements. Employers and purchasers can and must be part of the solution.”

The study builds upon previous research conducted by the actuarial firm Milliman, revealing a lack of improvement in out-of-network utilization disparities between 2013 and 2021.

The new report, commissioned by the Mental Health Treatment and Research Institute, with partial funding from organizations including the American Psychiatric Association, the American Psychological Association, and the National Association for Behavioral Healthcare, emphasizes the pressing need to address the ongoing disparities in mental health care access. As the nation grapples with a mental health crisis, initiatives aimed at achieving parity in access to care are more crucial than ever.

References

1. Mark TL, Parish WJ. (2024). Behavioral health parity – pervasive disparities in access to in-network care continue. April 17, 2024. Accessed April 17, 2024. https://www.rti.org/publication/behavioral-health-parity-pervasive-disparities-access-network-care-continue

2. New study finds continuing pervasive disparities in access to in-network mental health and substance use disorder treatment. News release. RTI International. April 17, 2024. Accessed April 17, 2024. https://www.rti.org/news/study-disparities-in-network-access-mental-health-sud-treatment

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