Wednesday, July 13, 2022 | The Latest Research, Commentary, And News From Health Affairs
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Phantom Medicaid Networks
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 Podysseyto discuss the research in greater detail.
"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.
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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.
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