ABSTRACT
Commercial plans were consistently more accurate than both Covered California marketplace and Medi-Cal plans. [...]plans were highly limited in providing timely access to urgent care and general appointments, although Medi-Cal plans outperformed plans from both other markets when it came to timely access. Am J Manag Care. 2023;29(2):96-102. https://doi.org/10.37765/ajmc.2023.89318 _____ Takeaway Points * California has some of the strictest network regulations. * Nonetheless, mental health provider directories are highly inaccurate. * Moreover, consumers also lack access to timely care in many cases. * It is time to rethink network regulation and invest more into oversight. _____ Mental health services have long been an afterthought in the US health care system, with lack of care compounding the stigmatization and exclusion that individuals struggling with mental health issues face.1-3 It is established that lack of access to these services may impose significant individual and societal costs.4 However, although a variety of statutory changes in the past 2 decades has expanded mental health coverage requirements, consumer access to mental health services remains limited,1,2,5,6 a situation that has only been exacerbated by the COVID-19 pandemic.7,8 Highlighting the lack of access, consumers are substantially more likely to see an out-of-network provider for mental health care than for other types of care.9-11 Yet, 2 potential barriers to accessing mental health care—the interlinked issues of inaccurate provider directories and inadequate provider networks—remain underassessed.4,12 Given the vital role that provider directories and provider networks play in connecting consumers to care, inaccurate provider directories and inadequate provider networks may potentially harm both the health and the financial well-being of consumers. Most obviously, there is the time-intensive administrative burden of combing through faulty directory entries and calling offices to find in-network doctors.13 But even more concerningly, the inability to locate an accessible in-network provider may lead to delayed or foregone care.4,14,15 Directory errors and inadequate networks also impose financial risks to consumers when consumers knowingly seek care outside of their network because there is not adequate access to in-network care.11,16-19 Evidence also suggests that these burdens disproportionately affect disadvantaged populations.20,21 Finally, directory errors raise systemic concerns about the efficacy of health care regulation because regulators extensively rely on directory data for regulatory assessments of networks.4,22 Concerns about inaccurate provider directories and inadequate provider networks have sparked limited policy responses at both the state and federal levels.4,23-25 The federal government has directory accuracy regulations in place for Medicare Advantage, Medicaid, and marketplace plans, and a federal law governing directory accuracy for all other plans came into effect in 2022.26 In addition, a minority of states have taken some action to improve directory accuracy, and slightly more than half of all states have put in place quantitative network adequacy standards.11,24,27 Overlapping policies specific to directories and networks are state and federal parity laws that aim to ensure adequate coverage of and access to mental health care.28 Although scholars have begun to pinpoint directory errors and timely access to appointments as key barriers to health care, most of what we know about provider directory accuracy and timely access is based on a small "secret shopper" survey conducted at a single point in time.11,29-31 The present analysis overcomes these limitations by making use of annual reports that nearly all plans regulated by the California Department of Managed Health Care (DMHC) must submit. [...]when making comparisons for accuracy and timely access across markets, we used t tests to determine whether differences are statistically significant.