Are Mental Health Patients Worse Off in ACA Marketplace?

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Participation in mental health networks was low compared with primary care networks with only 42.7% of psychiatrists and 19.3% of non-physician mental health care providers participating in a network.
Participation in mental health networks was low compared with primary care networks with only 42.7% of psychiatrists and 19.3% of non-physician mental health care providers participating in a network.

HealthDay News — Networks in mental health are generally narrower than in primary care, with plan networks including 11.3% of mental health providers practicing in a given state-level market, according to a study published in Health Affairs.

Jane M Zhu, MD, from the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues examined how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers using data from 2016 for 531 unique provider networks in the Affordable Care Act Marketplaces.

The researchers found that participation in mental health networks was low compared with primary care networks, with only 42.7% and 19.3%, respectively, of psychiatrists and non-physician mental health care providers participating in any network. Plan networks included 24.3% and 11.3%, respectively, of all primary care providers and mental health care providers practicing in a given state-level market, on average.

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"These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations: that insurers cover mental health services on a par with general medical and surgical services," the authors write. "Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity."

Reference

Zhu M, Zhang Y, Polsky D. Networks in ACA marketplaces are narrower for mental health care than for primary care. Health Aff (Millwood). 2017; 36(9): 1624-1631. 

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