Examining phantom networks
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Wednesday, July 13, 2022 | The Latest Research, Commentary, And News
From Health Affairs
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Phantom Medicaid Networks
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Patients and regulators rely on lists of in-network providers and
facilities to make insurance-related choices and assessments. Studies
show, however, that these lists can contain widespread inaccuracies.
In the July Issue, Jane Zhu and coauthors analyze "phantom networks"
and how they contribute to discrepancies between reported and realized
mental health care access in the Oregon Medicaid system.
The authors describe phantom networks as those that "may satisfy network
adequacy requirements on paper but not in practice, potentially
including providers who hold active licenses but are clinically
inactive, have moved, or have closed their panels to new patients."
Zhu and coauthors find that "in 2018, 58.2 percent of primary care and
specialty mental health providers in health plan directories, including
two-thirds of mental health prescribers, were listed but did not see
patients in the plan."
Zhu also joined A Health Podyssey
  to
discuss the research in greater detail.
A Perspective by Howard Goldman corroborates the findings in Zhu and
coauthors' article, elaborating on broader lessons in health policy
that relate to phantom networks.
"Phantom networks haunt the terrain of policy implementation, making it
difficult for people in need to take advantage of the hard-fought gains
in mental health insurance protections that resulted from decades of
reform," Goldman writes.
Brett Dolotina and Jack Turban also describe phantom networks as
structural barriers
that prevent youth-particularly youth of color-from obtaining mental
health services. The authors call for oversight of directories to ensure
equitable access to pediatric mental health services.
Want to read more? Explore our peer-reviewed journal and unlock the
Health Affairs archive dating back to 1981 by becoming a Health Affairs
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Elsewhere At Health Affairs
Today in Health Affairs Forefront, Marc A. Cohen and coauthors examine
how person-centered care can achieve the "triple aim"
of addressing care, health, and cost and transform the health care
system into a deeply individualized system of care.
Joan Alker and coauthors write about continuous Medicaid coverage for
young children
,
and call for the Biden administration to approve Oregon's request to
cover children until their sixth birthday.
Are you enjoying articles from Forefront? Consider joining Health
Affairs Insider
to show your support for high value health policy news, commentary, and
analysis.
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Daily Digest
Phantom Networks: Discrepancies Between Reported And Realized Mental
Health Care Access In Oregon Medicaid
Jane M. Zhu et al.
How Phantom Networks And Other Barriers Impede Progress On Mental Health
Insurance Reform
Howard Goldman
Phantom Networks Prevent Children And Adolescents From Obtaining The
Mental Health Care They Need
Brett Dolotina and Jack Turban
Could Person-Centered Care Be The Secret To Achieving The Triple Aim?
Marc A. Cohen et al.
The Biden Administration Should Approve Oregon's Request To Cover
Children Until Their Sixth Birthday
Joan Alker et al.
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