Evaluation of transparency and quality of provider networks associated with mental health care in large group and marketplace insurance plans in North Carolina

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Last Modified
  • March 28, 2022
Creator
  • Huang, Yao-Hsuan
    • Eshelman School of Pharmacy
Abstract
  • Introduction: The Mental Health Parity and Addiction Equity Act (MHPAEA) and the extension of the Affordable Care Act (ACA) mandate that health insurance plans include access to mental health services in parity with physical health services. Nonetheless, patients with mental health conditions constantly face difficulties in getting access to mental health providers. It is challenging for patients to intepret the quality of different provider networks when shopping through insurance websites. Current literature has examined the accuracy of information from provider networks and the challenges for insured patients accessing mental healthcare However, differences of quality of provider networks between urban and rural areas, and between different types of insurance were not fully studied. The objective of this secret shopper study was to evaluate the transparency and quality of provider networks from the largest insurance providers in North Carolina. Methods: In this cross-sectional observational secret shopper study, four secret shoppers attempted to call 400 healthcare facilities in two urban and two rural counties in North Carolina to ask for a mental health appointment under a large group insurance plan or marketplace insurance plan. Through phone calls, quantitative data were collected, which include wait time until the first appointment, number of times there is inaccurate provider information, number of providers that accept new patients, and number of successfully made appointments. The results were converted into percentages and then compared between groups. Results: Among 392 phone calls, 15% of them successfully led to a mental health appointment (13% of urban and 17.71% of rural healthcare facilities) while mean wait time until the first appointment was 32.95 days. Overall, there were no significant differences in most quality characteristics between urban and rural counties, and between large group insurance and marketplace insurance. Conclusion: This secret shopper study illustrates that the problem of accessing mental health services is still an issue. The information in the insurance provider directory is often inaccurate. Patients continue facing challenges reaching out to healthcare providers for mental health services even when covered by healthcare insurance. Although no significant difference was detected between plans and urban or rural areas, there is an accessibility gap between different areas and different insurance types. Therefore, more updated provider information is needed to help patients recognize the quality of provider networks and save time reaching out to providers.
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  • In Copyright
Advisor
  • Thomas, Kathleen
    • Eshelman School of Pharmacy
Degree
  • Doctor of Pharmacy
Graduation year
  • 2022
Language
  • English

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