Phantom Networks: Discrepancies Between Reported And Realized Mental Health Care Access In Oregon Medicaid.
Phantom Networks: Discrepancies Between Reported And Realized Mental Health Care Access In Oregon Medicaid.
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DOI：
10.1377/hlthaff.2022.00052
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发表时间：
2022-07
期刊：
影响因子：
9.7
通讯作者：
McConnell, K. John
中科院分区：
文献类型：
--
作者：
Zhu, Jane M.;Charlesworth, Christina J.;Polsky, Daniel;McConnell, K. John
了解受益人在多大程度上可以“实现”获得报告的提供者网络是必要的精神卫生保健，那里有显着的未满足的需求。我们比较了网络目录中的提供者列表与根据2018年1月1日至12月31日期间在俄勒冈州医疗补助管理医疗组织注册的64岁及以下成员的行政索赔经验构建的提供者网络。“网络内”提供者是那些为至少五个参加特定健康计划的独特医疗补助受益人提交任何医疗索赔的人。他们包括初级保健提供者，专业心理健康处方医生和非处方心理健康临床医生。总体而言，58.2%的网络目录列表是“幽灵”提供者，他们没有看到医疗补助患者，包括67.4%的心理健康处方者，59.0%的心理健康非处方者和54.0%的初级保健提供者。在目录中列出的提供者和登记者可以访问的提供者之间的显著差异表明，如果基于目录信息，则提供者网络监控和执行可能不足。
Understanding the extent to which beneficiaries can “realize” access to reported provider networks is imperative in mental health care, where there are significant unmet needs. We compared listings of providers in network directories against provider networks empirically constructed from administrative claims among members who were ages sixty-four and younger and enrolled in Oregon’s Medicaid managed care organizations between January 1 and December 31, 2018. “In-network” providers were those with any medical claims filed for at least five unique Medicaid beneficiaries enrolled in a given health plan. They included primary care providers, specialty mental health prescribers, and nonprescribing mental health clinicians. Overall, 58.2 percent of network directory listings were “phantom” providers who did not see Medicaid patients, including 67.4 percent of mental health prescribers, 59.0 percent of mental health nonprescribers, and 54.0 percent of primary care providers. significant discrepancies between the providers listed in directories and those whom enrollees can access suggest that provider network monitoring and enforcement may fall short if based on directory information.
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