Shrink Rap News: Helping patients access outpatient psychiatric care

How often does someone ask you for help in getting an appointment with a psychiatrist? With the “double expansion” in access to mental health care – because of the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act (ACA) – many more people are seeking help for mental health and substance use problems. But without more practitioners being produced, the waiting lists are getting longer.

A recent study found that 40% (146 of 360) of psychiatrists listed on insurance plans in three states could not be reached. Of the 214 who were reachable, 43% were unavailable, either because the psychiatrists were not accepting new patients or because they did not treat adult outpatients (e.g., inpatient only). Of the 123 psychiatrists left, the callers were able to schedule appointments with 93 (76%) of them. These results are similar to a 2007 study, where 44% of mental health professionals from seven health plans were unreachable.

[RW] Elements of a patient-centered provider directory

Problems with access to psychiatric care is not a new problem. Mental health carve-outs are used by managed care organizations (MCOs) to manage the mental health benefits, but create inefficiency in claims management and clinical care coordination. While this model seems to be losing popularity, these managed behavioral health organizations (MBHOs) often do not integrate well with the MCO, may not share the same standards for network adequacy, and often have different provider directories from those of the MCO, making it more complex for patients to access providers.

While the Parity Act has somewhat improved the problem of rate disparities, the historically low rates paid to psychiatrists by MBHOs have led to high levels of insurance nonparticipation, as much as 50%. Compounding this problem is the fact that plan members often find it hard to access those practitioners who do participate with their insurance.

The Maryland Psychological Association conducted in 2007 with Open Minds a “secret shopper” survey of more than 900 behavioral health providers from seven different online carrier directories in Maryland. Their goal was to assess the extent to which problems with access to care were related to inadequate insurance provider directories.

They found that 44% of the listed providers were unreachable based on the contact information in the directories, and only a small proportion was actually able to see the new “patient” in an appropriate time frame. The average wait time for a psychiatrist was 20 days, for a psychologist was 15 days, and for other mental health professionals was 11 days.