We may also need to determine what the minimum level of benefit is for each “metal level.” Metal, as in bronze, silver, gold, and platinum. People will be able to purchase plans that have higher levels of coverage for a higher premium. How we do that is not yet clear.
We also have to address health disparities. This often refers to the barriers that prevent minorities from receiving good health care, but it can also be interpreted to address barriers that people with mental illness have in accessing somatic care. We know that people with chronic mental illness have a foreshortened life span – some dying as much as 25 years earlier. Now, that’s a disparity.
Another aspect that our committee will address is network adequacy. There needs to be a mechanism for people looking at plans to determine if there are enough providers in the area to meet their needs. Health plans have a history of not doing a good job in this department, especially in behavioral health.
A couple years ago, I was helping a patient in the emergency department find a mental health provider. There were 27 providers listed in her online provider directory. I called every single one. Two were able to see her. The rest were either no longer practicing, wrong number, no answer, no longer accepting patients from that payor, or only treated inpatients. And one was deceased.
A 2007 study from the Maryland Psychological Association found that, of the 909 phone calls to mental health providers in health plan directories, 44% were unreachable. Only 161 gave answers about appointment availability. The worst plan, Blue Cross & Blue Shield, took an average of 38 days for an adult patient to be seen during the day, according to the study. Most people would not call this an adequate network.
I am hoping to get measures put in place that automatically monitor for adequate network coverage. For example, a plan can take claims data by provider and indicate next to each provider’s name the number of outpatient claims for initial visits received over the most recently available 12-month period. If you never accept new patients for that payor, the number would be zero. Thus, a patient wouldn’t bother calling that provider. A directory that has mostly zeroes would indicate an inadequate network, and thus someone looking for a plan might want to skip that one. This is called transparency, and I hope this committee will support it.
Did I mention the time frame for making all these decisions?
End of June.
2012!
I truly hope we can complete this task and do a good job. I question our ability to do so, but I know we will do our best.
For those of you in other states, I strongly recommend that you google “[state] health benefit exchange” to discover what your state’s process is for designing these exchange plans. Find the planning website for it. Learn the meeting schedule. Attend, speak up, send them public comments, make noise. If not, you and your patients will pay the price later.
—Steven Roy Daviss, M.D., DFAPA
DR. DAVISS is chair of the department of psychiatry at the University of Maryland’s Baltimore Washington Medical Center, chair of the APA Committee on Electronic Health Records, co-chair of the CCHIT Behavioral Health Work Group, and co-author of Shrink Rap: Three Psychiatrists Explain Their Work, published by Johns Hopkins University Press. In addition to @HITshrink on Twitter, he can be found at drdaviss@gmail.com, and on the Shrink Rap blog.