Why is now an important time to reassess how the behavioral healthcare industry measures network adequacy? 

With the rise of telemedicine and increased adoption of electronic health records (EHR) in behavioral healthcare, accurately measuring network adequacy and improving overall access to high-quality care has become crucial for payers. However, there are no established standards for what constitutes a "good" network size. The COVID-19 pandemic accelerated the adoption of telemedicine and a 2022 Alma survey found that 70% of providers wanted to maintain an entirely virtual practice. Traditionally, payers have relied on provider-to-patient ratios and travel distance metrics to gauge specialty provider availability. However, with the shift away from in-person care as the primary option, these metrics may no longer be as useful.

At the same time, the options for EHR tools have significantly increased and many platforms now offer tools like online scheduling that make it easier for clients to schedule sessions with providers in real-time. This scheduling data provides granular insight into the number of clients who can access the care they need, offering more detailed information than ever before. Considering these changes in recent years, there is an opportunity to redefine how the industry assesses network adequacy in a way that accurately reflects modern behavioral healthcare delivery. This data is critical because it drives strategic decisions for network growth, helps ensure client needs are met, and confirms compliance with regulatory requirements for access.

Alma has developed a framework to evaluate network adequacy, tell us a little more about that. 

Keeping the industry shifts we’ve seen in mind, Alma sees an opportunity to adopt a new framework for evaluating network adequacy that could help payers improve client access to behavioral health care. This framework involves three key pillars for measuring client outcomes:

• Clinically appropriate appointment availability: Rather than focusing primarily on the number of providers in a specific geographic area, payers can instead evaluate the number of available appointments that meet clinical needs. These key metrics include days to care (days from initial appointment request to first appointment), provider availability, and appointments per covered life. 
• Provider-patient fit: New search tools help healthcare providers connect and schedule with clients who can benefit from their specific areas of expertise. At the same time, new data presents the chance to assess how satisfied clients are with a provider, and how well their needs are being met. These key metrics include care length optimization, return rate, and searches leading to results (or client matches). 
• Clinical outcomes and quality: Incorporating data measuring care quality and patient outcomes can help create a more complete definition of network adequacy. This also offers the opportunity to make informed decisions on where to invest, to maximize the client experience. These key data metrics include PHQ-9 and GAD-7 score improvements and assessment and follow-up rates.

How does this proposed framework assist payers in ensuring that client needs are met while making strategic decisions for network growth? How does it help to address mental health parity for providers and payers today?

Behavioral health care is highly personalized and there is no one-size-fits-all approach. A large part of high-quality mental health care delivery is supporting clients in finding the right provider at the right time.

By measuring metrics such as days to care, provider availability, and appointments per covered life, this proposed framework ensures that clients have timely access to the care they need, reducing wait times and improving appointment availability. Advanced search tools and data on provider-patient fit help match clients with providers trained to offer the specific type of care they’re seeking, enhancing the effectiveness of care and client satisfaction. Additionally, incorporating data on clinical outcomes, such as improvements in PHQ-9 and GAD-7 scores, allows for continuous assessment of care quality and progress, ensuring that client needs are addressed.

With a renewed focus on mental health parity, the framework promotes equal access to care by shifting the focus from geographic location to appointment availability, ensuring all clients have access to necessary mental health services regardless of location. The emphasis on personalized provider matching and outcome-based measurements ensures that mental health services are delivered in a manner that meets the same standards of quality and accountability as other types of healthcare. By providing detailed data on client needs, preferences, and outcomes, the framework supports informed strategic decisions for network growth and ensures compliance with mental health parity laws, fostering a more equitable and efficient mental health care system.

What advice would you offer payers who would like to take the first steps to transition into more data-driven care delivery and outcomes measurement?

I would suggest that payers utilize the data they already have access to and collaborate with their provider partners to leverage that data for building and informing future networks.

Payers have thousands of clients who visit their directories and other digital experiences searching for care. This is an important part of the process and, when combined with the data that technology-enabled providers have and their clinical expertise, payers will be able to assess the true demands for care across different markets. They will also be able to demonstrate where they’re adequately addressing the needs of the market, and more efficiently close gaps in their networks, improving the experience of accessing care for clients.

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