Provider lists must include quality ratings

February 28, 2014

Health plans should consider turning to their members to ask for quality feedback.

 

Providing a list of in-network providers online is a start, but experts say service and quality information should also be highlighted for members. The issue is especially concerning to mental-health advocates who say patients have a difficult time navigating the system and finding adequate providers.

A 2014 report to Congress says that about 55% of the country’s 3,100 counties have no practicing psychiatrists, psychologists or social workers and clinicians are leaving the profession. Maintain an adequate network of behavioral health providers can be especially difficult in rural areas and for Medicaid populations that tend to have higher needs for mental and behavioral services.

“As a society, we need to start looking at funding for the education and training of more mental health professionals,” says Carolyn Wolf, executive partner, Abrams, Fensterman, Fensterman, Eisman, Formato, Ferrara & Wolf, LLP and director of the firm’s mental health law practice. “Even in-house providers who are full-time faculty and staff need to have the resources to be able to keep patients longer and to offer better discharge planning and better services in the community so we can to move patients through the system more effectively and more efficiently.”

Find a facility

Jamison Monroe, CEO of Newport Academy, with adolescent treatment centers located in Southern California and Connecticut, says that there are still barriers to mental health treatment, including a lack of providers and information about the providers. 

“We get over 1,000 calls a month, yet we can only really treat about 5% of those ourselves and refer the rest based on health needs, financial and economic needs and insurance coverage,” he says. 

Wolf says that the industry would benefit from the creation of a centralized database to allow consumers to vet the quality and capacity of mental health providers on managed care provider lists.

“Through the managed care websites, mental healthcare providers are supposedly ‘easy’ to find, but there’s really no way of differentiating how good or effective they are,” she says. 

When patients try to seek specialized care, more detailed information should be provided, including where provider’s credentials and any disciplinary actions can be checked, she says. 

Some insurer sites are better than others at listing in-network providers online. However the issue can also be complicated by carve-out behavioral health services. When plans use carve-outs, the site should have a seamless connection to the network listings.

Monroe says more specific information should be listed for facilities’ services provided as well.

“Some sites give you a name of a facility that has a similar licensure, but it may be a three-to-five-day psychiatric stabilization center, when in fact someone’s looking for a long-term partial hospitalization treatment program,” he says. 

Health plans should consider turning to their members to ask for quality feedback, Wolf says. Surveying those who have used in-network providers would prove useful in determining whether the mental healthcare services received were adequate.