NCQA Discusses Behavioral Health Access at NASEM Workshop
July 31, 2024 · Becky Kolinski
The National Academies of Sciences, Engineering, and Medicine (NASEM) hosted a virtual public workshop to address workforce challenges across behavioral healthcare. The workshop convened a panel of experts to discuss perspectives on the behavioral health workforce shortage: payment and policy issues, the impact on patient care, promising innovations, and the use of technology in behavioral healthcare.
NCQA seeks to improve quality and access for behavioral health services. We accredit managed behavioral healthcare organizations (MBHO), and have incorporated more than 25 behavioral health measures in HEDIS® (Healthcare Effectiveness Data and Information Set) measures. Many of our HEDIS measures are used in quality reporting and value-based purchasing by Medicare, Medicaid and commercial insurance plans.
Julie Seibert, PhD, NCQA’s Assistant Vice President, Behavioral Health, shared recent NCQA research on behavioral health network adequacy.
Defining the Behavioral Health Access Problem
The need for behavioral health treatment has never been more pressing, but there are wide disparities in access to care. According to the National Survey on Drug Use and Health, over 50% of adults with a mental health condition, and over 75% of individuals with a substance use disorder, don’t receive the treatment they need.
Measuring behavioral health network adequacy is difficult. Network adequacy standards vary from state to state, as do the systems state regulators use to ensure compliance with those standards. And although a bundle of standards is needed to capture all aspects of network access, most states have adopted only one standard.
The situation is further complicated by behavioral health workforce shortages, low reimbursement rates and complex practitioner licensure laws.
Key Findings from NCQA’s Research
NCQA interviewed 17 stakeholder groups—providers, consumer advocates, health plans, employers, regulators, research and policy experts—for their perspective on behavioral health network adequacy.
“Our goal was to gain a greater understanding of strengths in existing network adequacy metrics and standards and to identify gaps where new metrics or standards could be developed,” says Seibert.
The overwhelming response was that network adequacy should be defined based on services, not on provider types or facilities. Survey respondents also felt that mental health services should be separate from services for substance use disorders and that states should consider incentives to ensure adequate behavioral health networks.
What We Learned at the NASEM Workshop
“Network adequacy is a multi-faceted issue. There is no one way to solve it, and there is no one way to measure it,” says Seibert.
It will take a combination of strategies to tackle this complex issue:
- Expand the use of integrated behavioral health strategies.
- Use different types of workers, such as peer specialists and community health workers, where appropriate.
- Obtain additional guidance on appropriate use of telehealth services.
- Expand and provide sustainable support for crisis services.
“We are hopeful that developing and deploying multiple measures of behavioral health network adequacy can improve access and quality of care,” says Seibert.
Additional Resources
You can view the recording of the workshop on the NASEM website here. Slides from the speaker presentations are also available on the website.
You can download NCQA’s research paper on behavioral health network adequacy here.
NCQA’s research was funded by the Sozosei Foundation, a philanthropic arm of Otsuka. The Foundation’s primary focus is to eliminate the use of jails and prisons for the diagnosis and treatment of mental illness by improving access to mental health care in communities. Visit www.sozoseifoundation.org to learn more.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
