If you鈥檝e got a plan offered on the federal health law鈥檚 insurance marketplace and you鈥檙e looking for a therapist, you may have to look really hard: The average provider network includes only 11 percent of all the mental health care providers in a given market, according to a .
An average marketplace plan鈥檚 network, the study added, includes just under a quarter of all psychiatrists 聽and 10 percent of all non-physician mental health care聽providers.聽Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants,聽and聽 behavioral specialists, counselors and therapists with master鈥檚 or doctoral degrees.
In addition, the researchers reported that fewer than half of all psychiatrists and a fifth of non-physician providers participated in any marketplace plan.
The problem isn鈥檛 unique to marketplace plans, said study co-author Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. However, this study, which was published in the September issue of Health Affairs, sheds more light on the challenges insurers face in trying to develop networks of mental health care providers, he said.
At the same time, the narrow networks 鈥� those that generally have fewer than 25 percent of participating doctors and other health providers in the area 鈥� that many insurers have adopted to help keep marketplace plan premiums lower may exacerbate the problem of finding mental health services, Polsky said.
High demand for services, a shortage of practitioners and low insurance reimbursement rates have all contributed to mental health care providers鈥� general lack of enthusiasm for joining provider networks, according to the study.
For comparison, the study also analyzed the average network participation of primary care providers in marketplace plans. It found that the average network for ACA plans included 24 percent of all primary care providers in a given market, more than twice the proportion of mental health care providers.
The study examined 2016 data for 531 provider networks offered by 281 insurance carriers in the marketplaces in every state plus the District of Columbia using data from the Robert Wood Johnson Foundation.
The 聽requires that health plans鈥� mental health services be at least as generous as medical/surgical services. That has provided financial protection for consumers, but access to in-network providers remains a problem.
In recent years, primary care physicians have increasingly provided mental health services. The study suggests that enhancing the collaboration between primary care physicians and mental health specialists is vital to improving access to mental health care.
鈥淚 would argue that the challenge isn鈥檛 necessarily a lack of primary care physicians, it鈥檚 a need to reorganize care to meet the needs of the population,鈥� Polsky said. 鈥淭eam-based care is an opportunity to meet those needs.鈥�
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