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According to a new study.
More than half of the counties the researchers studied did not have a single psychiatrist participating in a Medicare Advantage plan, the private sector equivalent of traditional health insurance. Some 30 million people, a little more than half of all federal program participants are enrolled in these private plans.
The researchers, in a paper published Wednesday in the journal Health Affairs, found that of the plans examined, nearly two-thirds were narrow, with less than a quarter of psychiatrists available in a plan’s network. Networks offered under an Obamacare or Medicaid managed care plan were not as restrictive and included about 40% of available psychiatrists, the study found.
The “more limited networks present a frustrating additional barrier in mental health services even when, on paper, there are sufficient numbers of providers in a geographic region,” the researchers wrote.
The pandemic has helped reveal a widespread need for mental health services among older Americans, many of whom are struggling with loneliness, the loss of a loved one, or the deterioration of their own health. While about one in four people on Medicare suffers from a mental illness like depression, anxiety or schizophrenia, an estimated half or fewer receive treatment, according to a recent study. analysis mental health coverage from the Commonwealth Fund, a not-for-profit group.
“We need systems in place so people can easily find and pay for the care they need,” said Gretchen Jacobson, vice president of Medicare at the Commonwealth. “It’s not clear that people are able to do that.”
Difficulty finding a psychiatrist is not unique to Medicare Advantage policyholders, in part because of increased demand. The scarcity of psychiatrists, especially those willing to accept insurance, makes it difficult for plans to find providers. Many psychiatrists have also chosen not to see patients under traditional health insurance, according to a recent report.
“Part of what’s happening is we have this big problem of a shortage of psychiatrists and mental health care providers,” said Beth McGinty, head of the health policy and economics division. at Weill Cornell Medicine and author of the Commonwealth Report. “It’s exacerbated here.”
Because getting off the grid is expensive, many people will delay or skip treatment, said Dr. Jane M. Zhu, one of the study authors and a primary care physician at Oregon Health and Science University. She said her own patients often had difficulty finding help.
“I was referring them, but they just couldn’t get access to mental health providers,” Dr. Zhu said. One of her patients called more than a dozen providers before getting an appointment, she said.
Insurers say their goal is to provide a wide range of mental health services. “Everyone deserves access to effective, affordable and equitable mental health support,” Kristine Grow, a spokeswoman for AHIP, a trade group representing insurers, said in an email.
But Ms Grow criticized the Health Affairs study for not comparing the plans with traditional health insurance and for not looking at other types of mental health services available to patients that would be provided by others. clinicians or via telehealth. “Essentially, this study uses a very narrow definition of mental health clinician to prove a preexisting thesis about Medicare Advantage,” she said.
More generally, regulators and legislators have expressed concern that people participating in private health insurance plans may not receive the services to which they are entitled under the federal program. Critics have long complained about insufficient access to mental health services.
Senator Ron Wyden, the Oregon Democrat who heads the Senate Finance Committee, held an audience in May on so-called “phantom networks” of mental health care providers, in which many clinicians listed in Medicare Advantage plan directories do not, in fact, accept patients. His staff surveyed secret clients and were only able to get an appointment 18% of the time.
The Health Affairs study may have overestimated the availability of psychiatrists because it only looked at providers listed in the plan’s directory, Dr. Zhu said. “It probably paints a rosier picture,” she said.
Physicians may not want to participate in Medicare Advantage plans because of low payments from insurers coupled with all the required paperwork, said Dr. Robert Trestman, chair of the council on health care systems and funding for the Medicare Advantage. ‘American Psychiatric Association and testified at the Senate hearing. “A lot of challenges and frustrations are underlined in Medicare Advantage plans,” he said.
Some insurers pay psychiatrists less under their Medicare Advantage plans than traditional health insurance pays for the same services, the researchers said. The plans may also have an incentive to contract with a smaller group of doctors to have more control over the cost and care provided, the researchers said.
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