Behavioral Health Networks: What We Know Now

February 8, 2024 · Andy Reynolds

Improving Accountability for Behavioral Health Care Access is our latest white paper summarizing savvy measurement of behavioral health networks.

Developed in consultation with The Sozosei Foundation, the 26-page report is a handbook for assessing whether behavioral health networks are up to the challenge of tackling America’s mental health and substance abuse crises.

The Context

Many people struggle to find behavioral healthcare. When they look at a provider directory, they may not understand what type of provider to see.

Once people start calling providers, they can run into a dead end: The phone number’s out of date, the provider’s not accepting new patients, there’s a 6-month wait for an appointment.

For many people, these roadblocks make them forgo care.

Eight Takeaways

The environmental scan at the heart of our report yields eight main lessons:

  1. What we’ve got isn’t good enough. Network adequacy standards need to be better. We need a mix of metrics to capture the factors that matter.
  2. Inconsistent, passive data collection hurts. Standardization and proactive data collection are the best way to understand consumer perspectives and satisfaction.
  3. Measuring behavioral health networks is different. Don’t fixate on provider-to-enrollee ratios. It’s better to track services than providers and facilities.
  4. Inaccurate directories distort understanding. Outdated, incomplete directories (“ghost networks”) complicate measurement of behavioral health networks.
  5. Don’t underestimate variation. Differences in wait times and geographic standards vary. And they matter.
  6. Measurement mishmash mars comparison. Regulators in different places and at different levels of authority use different methodologies, data sources and transparency standards. Those differences undercut benchmarking.
  7. Incentives matter. Use carrots and sticks to strengthen behavioral health networks and enforce expectations.
  8. A good network isn’t a panacea. A strong network of behavioral health providers is necessary, but not enough to ensure access.

Adding to the Challenge

The gap between access to behavioral health and medical care is widening. This is despite behavioral health parity laws that aim to put all care on equal footing.

  • Workforce shortage. A national workforce shortage has made it harder for health plans to maintain adequate behavioral health networks.
    • More than half of U.S. counties are behavioral health workforce shortage areas.
    • There aren’t enough psychiatrists to meet the need in all 50 states.
  • Lack of network adequacy standards. State-based network adequacy standards compel health plans to have enough providers and facilities to ensure reasonable access to health care services.
    • There are no national standards for behavioral health network adequacy.
  • Equity problems. Access to behavioral health care is inequitable—and is therefore a quality problem.
    • Judicial system. Prisons have become known as de facto mental health providers—especially for Black and Brown Americans.
    • Even outside the justice system, there are significant gaps in accessing care, based on race and ethnicity.

Go Deeper

In addition to the recommendations, the white paper discusses:

  • What works. The paper points to examples of improving access to behavioral health services.
  • Behavioral health providers. The paper’s appendix includes a handy summary illustrating the range of behavioral health providers, and listing education, training and certification requirements for different provider types.

The Hope

We hope the white paper helps improve patient experience by prompting:

  • New research. More evidence is needed on outcomes produced by the variety of network standards.
  • Pilots are needed for measures, as well as standard methods to evaluate compliance.
  • Expansion of providers. It’s likely that all health plans are struggling to maintain adequate behavioral health networks. We encourage them to consider expanding networks to include new provider types.
  • Models of care. Since behavioral healthcare often requires an integrated care team, there could be implications for value-based payment models.
  • Updates to the Mental Health Parity and Addiction Equity Act. If passed, pending legislation could improve monitoring and accountability for maintaining adequate networks.

Other Work

Our work on network adequacy standards informs how we evaluate continuity of care using HEDIS®.

Primary care physicians, pediatricians, peer support therapists and other providers are seeing patients for:

These measures will be up for public comment on February 13.

We are considering an expansion of providers eligible for follow-up.

Your Next Move

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