Out-of-network use much higher for behavioral
health care than medical care, with greater financial burden for
patients
RESEARCH TRIANGLE
PARK, N.C., April 17, 2024 /PRNewswire/ -- A new study
by health economists at nonprofit research institute RTI
International adds to recent research demonstrating a lack of
access to affordable mental health and substance use disorder
treatment in the U.S.
The study's findings, detailed in the report Behavioral
Health Parity – Pervasive Disparities in Access to In-Network Care
Continue, show that patients went out-of-network 3.5
times more often to see a behavioral health clinician than a
medical/surgical clinician, 8.9 times more often to see a
psychiatrist, 10.6 times more often to see a psychologist, 6.2
times more often for acute behavioral inpatient care, and 19.9
times more often for sub-acute behavioral inpatient care.
The study also revealed that in-network office visit
reimbursement, a key lever that health plans use to encourage
provider in-network participation, was higher for medical/surgical
clinicians than office visits with behavioral clinicians: 22%
higher on average; 48% higher at the 75th percentile; and 70%
higher at the 95th percentile. Notably, physician assistants were
reimbursed for office visits at an average amount 19% higher than
psychiatrists and 23% higher than psychologists.
"The finding of large disparities for out-of-network use and
reimbursement rates highlights that health plans are not using the
same measures to improve the adequacy of their behavioral health
provider networks as they do for medical networks," said lead
author Tami L. Mark, Ph.D.,
M.B.A., Distinguished Fellow and director of Behavioral Health
Financing and Quality Measurement at RTI. "Our findings echo recent
surveys and secret shopper studies that show much greater
dissatisfaction with, and lower access to, behavioral health
providers than medical/surgical providers."
Dr. Mark and co-author, William
Parish, Ph.D., used claims and enrollment data from more
than 22 million individuals captured annually from 2019 through
2021 to evaluate out-of-network use and reimbursement rates across
all 50 states.
"RTI concluded that high out-of-network use for mental health
and substance use treatment cannot be explained by a shortage of
behavioral health providers," said Henry
Harbin, M.D., senior advisor to The Bowman Family
Foundation. "If that were the explanation, we'd see the same
out-of-network use disparities for primary care physicians, which
are in even shorter supply than mental health providers, according
to HRSA, the federal agency that monitors health care workforce
shortages."
The study updates and expands on a previous analysis of
parity among privately insured individuals conducted by the
actuarial firm Milliman. A comparison between the 2013 and 2021
results reveals no improvement in disparities in out-of-network
use.
"Lack of access to affordable and effective care for mental
health is at crisis levels in the U.S.," said Shawn Gremminger, president and CEO of the
National Alliance of Healthcare Purchaser Coalitions. "This
research demonstrates the profound need for employers and
purchasers to demand more of their health insurance carriers to
ensure they are providing truly equitable access to behavioral
health care in compliance with parity requirements. Employers and
purchasers can and must be part of the solution."
The report was commissioned by the Mental Health Treatment and
Research Institute, a tax-exempt subsidiary of The Bowman Family
Foundation. A portion of the cost of the report was funded by the
American Psychiatric Association, the American Psychological
Association, and the National Association for Behavioral
Healthcare. The authors are responsible for the content and the
views expressed in the report.
Supporters of the report's recommendations include more than 40
of the nation's leading mental health and employer groups, many of
whom have provided comments about the importance of the research
and resulting recommendations, listed here.
Media Contacts:
RTI International
RTI Media Relations
376300@email4pr.com
919-708-8205
The Bowman Family Foundation
Cary Conway
376300@email4pr.com
972-649-4707
About RTI International
RTI International is an
independent, nonprofit research institute dedicated to improving
the human condition. Clients rely on RTI to answer questions that
demand an objective and multidisciplinary approach — one that
integrates expertise across the social and laboratory sciences,
engineering and international development. RTI believes in the
promise of science and is inspired every day to deliver on that
promise for the good of people, communities and businesses around
the world. For more information, visit rti.org.
About The Bowman Family Foundation
The Bowman Family
Foundation is a private foundation qualifying as 501(c)(3)
nonprofit organization. The primary mission of the Foundation is to
improve the lives of people with mental health and substance use
conditions. The Foundation also provides funding to support the
education and welfare of children. For more information, visit
thebowmanfamilyfoundation.org.
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content:https://www.prnewswire.com/news-releases/new-study-finds-continuing-pervasive-disparities-in-access-to-in-network-mental-health-and-substance-use-disorder-treatment-302119614.html
SOURCE RTI International and The Bowman Family Foundation