Clinical Review & Education
From The JAMA Network
Rates of Psychiatrists' Participation in Health Insurance Networks Janet R. Cummings, PhD
JAMA PSYCHIATRY
independent variables were physician specialty and year groupings (2 0 0 5 -2 0 0 6 ,2 0 0 7 -2 0 0 8 , and 2 0 0 9-2 0 1 0 ).
Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care Tara F. Bishop, MD, MPH; M atthew J. Press, MD, MSc; Salomeh Keyhani, MD, MPH; Harold Alan Pincus, MD
RESULTS The pe rcentage o f psychiatrists w h o accepted private n o ncapita ted insurance in 2009-2010 was significa ntly lo w e r th a n th e pe rcentage o f physicians in o th e r specialties (55.3%
[95% Cl, 46.7% -63.8% ] vs 88.7% [86.4% -90.7% ]; P < .001) and IMPORTANCE There have been recent calls fo r increased
access to m ental health services, b u t access may be lim ited o w ing to psychiatrist refusal to accept insurance.
had declined b y 17.0% since 2 0 0 5 -2 0 0 6 . Similarly, th e p e rce n t age o f psychiatrists w h o accepted M edicare in 200 9-2 0 1 0 was significa ntly lo w e r th a n th a t fo r o th e r physicians (54.8% [95%
Cl, 46.6% -62.7% ] vs 86.1% [84.4% -87.7%]; P < .001) and had OBJECTIVE To describe recent trends in acceptance o f
declined by 19.5% since 2 0 0 5 -2 0 0 6 . Psychiatrists' Medicaid
insurance by psychiatrists compared w ith physicians in other
acceptance rates in 200 9-2 0 1 0 were also lower than those for
specialties.
other physicians (43.1% [95% Cl, 34.9%-51.7%] vs 73.0%
DESIGN. SETTING, AND PARTICIPANTS We used data from a
2 0 0 5 -2 0 0 6 . Psychiatrists in the Midwest were more likely to
national survey o f office-based physicians in the United States
accept private noncapitated insurance (85.1%) than those in the
to calculate rates o f acceptance o f private noncapitated
Northeast (48.5%), South (43.0%), or West (57.8%) (P = .02).
[70.3%-75.5%],- P < .001) but had not declined significantly from
insurance, Medicare, and Medicaid by psychiatrists vs physicians in oth er specialties and to compare characteristics o f
CONCLUSIONS AND RELEVANCE Acceptance rates fo r all types
psychiatrists w h o accepted insurance and those w ho did not.
o f insurance were significantly lower fo r psychiatrists than for physicians in oth er specialties. These low rates o f acceptance
MAIN OUTCOMES AND MEASURES Our main outcom e variables
may pose a barrier to access to m ental health services.
were physician acceptance o f new patients w ith private
JAMA Psychiatry. 2014;71(2):176-181.
noncapitated insurance, Medicare, o r Medicaid. Our main
doi:10.1001/jamapsychiatry.2013.2862.
More than one-half o f individuals w ith a m ental illness do not re
o f psychiatrictreatm ent. A shortage o f psychiatrists participating in
ceive any mental health services.1Am ong those w ho perceive an un
insurance networks can result in long w a it tim es fo r an intake ap
m et need fo r m ental health services, financial concerns represent
po in tm e n t or an inability to find an in -ne tw o rk psychiatrist th a t ac
im portant barriers to care.1The im plem entation o f the Mental Health
cepts new patients. Patients w ho rely on o u t-o f-ne tw o rk psychia
Parity and A ddiction Equity A ct (MHPAEA) and th e A ffordable Care
trists fo r tre a tm e n t incur higher out-of-pocket costs due to higher
A ct (ACA) w ill p o te n tia lly reduce cost-related barriers to m ental
deductibles, copayments, coinsurance, and balance billing charges.3
health treatm ent by im provingthe level o f coverage for mental health
The low rate o f psychiatrist participation in health insurance net
services am ong those w ith health insurance and by expanding in
works is especially acute in th e Medicaid program, which is th e larg
surance coverage to previously uninsured populations.
est payer o f m ental health services in th e United States and dispro
In JAMA Psychiatry, Bishop e t al2 re p o rt results from th e Na
p o rtio n a te ly serves those w ith th e m ost disabling m ental health
tional Am bulatory Medical Care Survey showing low acceptance rates
disorders, such as schizophrenia.1 Bishop e t al2 found th a t slightly
fo r noncapitated insurance by psychiatrists. Bishop e t al found th a t
more than 4 o f 10 psychiatrists (43.1%) accepted Medicaid in 2 0 0 9 -
in 2 0 0 9 -2 0 1 0 , a low er percentage o f office-based psychiatrists ac
2010; o n ly d e rm a to lo gists had a lo w e r rate o f M edicaid accep
cepted private health insurance (55.3%) compared w ith other office-
tance. States th a t o p t into the ACA's Medicaid expansion w ill expe
based specialist physicians (88.7% ). Moreover, the rate o f partici
rience an increase in the percentage o f residents w ith m ental health
p a tio n in health insurance n e tw o rks has declined fa ste r am ong
disorders covered by Medicaid and in th e num ber o f users o f m en
psychiatrists in recent years than am ong oth er specialists.
tal health services.4 These changes are likely to stress th e already
The relatively small num ber o f psychiatrists accepting insur
190
overburdened system o f Medicaid m ental health practitioners.
ance may underm ine th e ability o f th e MHPAEA and th e ACA to re
Several factors likely co n trib u te to psychiatrists' low participa
duce financial barriers and expand access to care fo r those in need
tio n in Medicaid and o ther health insurance networks. One possi-
JAMA January 13.2015 Volume 313, Number 2
jama.com
From The JAMA N etw ork Clinical Review & Education
bility involves the relative reim bursem ent rates fo r the types o f pro
mental health care? One strategy is to incentivize greater participa
c e d u re s fo r w h ic h p s y c h ia tris ts are c o m m o n ly re im b u r s e d -
tio n among th e existing w orkforce in insurance plans by increasing
p s y c h o th e r a p y a n d m e d ic a tio n m a n a g e m e n t. B e ca u se
reimbursement rates fo r psychiatric services. However, in many mar
psychotherapy can also be provided by master's-level therapists, re
kets, it w ould be very costly fo r health plans to raise reim burse
im bursem ent rates fo r psychotherapy visits are low er relative to
m ent rates to high enough levels th a t could compete w ith w hat psy
m edication managem ent visits. The relative difference between
ch ia trists can charge p a tie nts w h o pay o u t-o f-p o cke t. A n o th e r
these reim bursem ent rates incentivizes psychiatrists w ho accept
approach is to increase the size o f the psychiatry workforce. H ow
health insurance to focus on m edication management visits.5 For
ever, this w ould take many years to im plem ent because o f the tim e
m any psychiatrists, however, a practice consisting o n ly o f tim e-
involved in training specialist physicians. Moreover, a larger w ork
lim ited m edication managem ent visits may be personally u n fu lfill
force may not increase the num ber o f psychiatrists w ho locate their
ing and at odds w ith th e ir values about how to practice good psy
practices in underserved areas or w ho accept health insurance.
chiatry. The coordination o f care w ith other clinicians and the delivery
A th ird approach, and potentially the most promising, is to fu r
o f culturally com petent, patient-centered care may require more
ther develop collaborative chronic care models (CCMs), which im ple
tim e than th e 10 to 15 minutes typically allotted fo r medication man
m ent team-based approaches to provide stepped care for those w ith
agement visits by insurance plans.
m ental illnesses and o ther chronic conditions.9 These models rely
The small size o f psychiatry practices may also co n trib u te to
on prim ary care clinicians to provide trea tm e nt fo r m ild to m oder
psychiatrists' low participation in health insurance networks. More
ate mental health disorders w ith support from case managers and
than half o f office-based psychiatrists have solo practices,2 which
consultation from m ental health specialists. Chronic care models
has substantial consequences fo r administrative costs among those
make e fficient use o f psychiatrists' tim e by enabling them to pro
w ho accept health insurance. The tim e required to negotiate con
vide decision support fo r prim ary care teams and direct treatm ent
tracts w ith insurance companies, file prior authorization forms, file
for patients w ith the most complex psychiatric needs. However, there
claims, and recover payments fo r services requires additional staff
are a num ber o f barriers to wide dissemination o f CCMs, such as lim
and a concom itant increase in office space. The revenue associated
ited fle x ib ility in reim bursem ent m echanism s to su p p o rt team -
w ith participation in insurance netw orks may n o t be sufficient to
based care, lim ited resources available to train participating physi
offset these additional overhead expenses fo r psychiatrists in solo
cians, and lim ite d in te g ra tio n o f health in fo rm a tio n te ch no lo g y
practices.
systems among comm unity-based clinicians to facilitate sharing o f
The overall shortage o f psychiatrists is a th ird fa cto r p o te n
patient medical records. By offering opportunities to develop infra
tia lly co n trib u tin g to low participation in insurance networks. Be
structures such as accountable care organizations fo r Medicare en-
cause more than three-quarters o f US counties have a severe sh o rt
roliees and medical homes fo r Medicaid enrollees w ith "serious and
age o f p s y c h ia tris ts ,6 th e a b sence o f c o m p e titio n can g ive
persistent mental illness," th e ACA m ight reduce these barriers for
psychiatrists the fle xib ility to choose how th e y w ant to practice and
ta rg e t populations and fa cilita te im p lem entation o f team-based
can facilitate the developm ent o f practices com prising exclusively
stepped-care approaches to m ental health treatm ent.
clients w ho can pay out-of-pocket. Supply-side trends also suggest
Recent federal laws th a t expand health insurance coverage for
th a tth e shortage may worsen in comingyears. The number o f gradu
mental health services have the potential to improve access to trea t
ates from psychiatry residency programs declined 14% between aca
m ent. If low rates o f psychiatrist p a rticip a tio n in insurance n e t
dem ic years 2 0 0 0 -2 0 0 1 and 2 0 0 7 -2 0 0 8 ,7 and the num ber o f psy
works persist, health care delivery models th a t make e fficient use
chiatrists has not kept pace w ith population g ro w th .8
o f psychiatrists'tim e am ongthose who do participate w ill be needed.
Given th e declining participation rate o f psychiatrists in insur
F urther de ve lo pm e n t and dissem ination o f collaborative team -
ance plans, how can health care delivery systems be m odified to en
based approaches offer one mechanism to m eet the needs for m en
sure th a t health insurance expansions result in im proved access to
tal health trea tm e nt in th e United States.
ARTICLE INFORMATION
REFERENCES
Author Affiliation: Department o f Health Policy
1. Behavioral health. United States, 2012 [HHS
and Management, Rollins School o f Public Health,
publication (SMA) 13-4797], http://www.samhsa
Emory University. Atlanta, Georgia.
.gov/data/sites/default/files/2012-BHUS.pdf. Accessed December 5,2014.
Corresponding Author: Janet R. Cummings, PhD, Department o f Health Policy and Management, Rollins School o f Public Health, Emory University,
2 . Bishop TF, Press MJ, Keyhani S, Pincus HA. Acceptance o f insurance by psychiatrists and the implications fo r access to mental health care. JAMA
6. Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP. County-level estimates o f mental health professional shortage in the United States. PsychiatrServ. 2009;60(10):1323-1328.
7. Faulkner LR, Juul D, Andrade NN, et al. Recent trends in American Board o f Psychiatry and Neurology psychiatric subspecialties. Acad Psychiatry. 2011;35(1):35-39.
1518 Clifton Rd NE, Room 650, Atlanta. GA 30322 ([email protected]).
Psychiatry. 2014;71(2):176-181.
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for
3. Kyanko KA, Busch SH. The out-of-network benefit: problems and policy solutions. Inquiry.
Disclosure o f Potential Conflicts o f Interest and none were reported.
2012-2013;49(4):352-361.
BHW0RK/PEP13-RTC-BHW0RK.pdf. Accessed December 5,2014.
Funding/Support: This work was supported by the
4. Garfield RL, Zuvekas SH, Lave JR, Donohue JM. The impact o f national health care reform on adults
9 . Woltmann E, Grogan-Kaylor A, Perron B, et al.
National Institute o f Mental Health (K01MH095823).
w ith severe mental disorders. Am J Psychiatry. 2011: 168(5):486-494.
Comparative effectiveness o f collaborative chronic care models for mental health conditions across
Role of the Funder/Sponsor: The funding source
5 . Harris G. Talk doesn't pay, so psychiatry turns
primary, specialty, and behavioral health care settings. Am J Psychiatry. 2012:169(8):790-804.
had no role in the preparation, review, or approval o f the manuscript.
instead to drug therapy. New York Times. March 5, 201TA1.
jama.com
8. Report to Congress on the nation's substance abuse and mental health workforce issues. http://store.samhsa.gov/shin/content//PEP13-RTC-
JAMA
January 13,2015
Volume 313, Number 2
191
Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
From The JAMA Network
Rates of Psychiatrists' Participation in Health Insurance Networks Janet R. Cummings, PhD
JAMA PSYCHIATRY
independent variables were physician specialty and year groupings (2 0 0 5 -2 0 0 6 ,2 0 0 7 -2 0 0 8 , and 2 0 0 9-2 0 1 0 ).
Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care Tara F. Bishop, MD, MPH; M atthew J. Press, MD, MSc; Salomeh Keyhani, MD, MPH; Harold Alan Pincus, MD
RESULTS The pe rcentage o f psychiatrists w h o accepted private n o ncapita ted insurance in 2009-2010 was significa ntly lo w e r th a n th e pe rcentage o f physicians in o th e r specialties (55.3%
[95% Cl, 46.7% -63.8% ] vs 88.7% [86.4% -90.7% ]; P < .001) and IMPORTANCE There have been recent calls fo r increased
access to m ental health services, b u t access may be lim ited o w ing to psychiatrist refusal to accept insurance.
had declined b y 17.0% since 2 0 0 5 -2 0 0 6 . Similarly, th e p e rce n t age o f psychiatrists w h o accepted M edicare in 200 9-2 0 1 0 was significa ntly lo w e r th a n th a t fo r o th e r physicians (54.8% [95%
Cl, 46.6% -62.7% ] vs 86.1% [84.4% -87.7%]; P < .001) and had OBJECTIVE To describe recent trends in acceptance o f
declined by 19.5% since 2 0 0 5 -2 0 0 6 . Psychiatrists' Medicaid
insurance by psychiatrists compared w ith physicians in other
acceptance rates in 200 9-2 0 1 0 were also lower than those for
specialties.
other physicians (43.1% [95% Cl, 34.9%-51.7%] vs 73.0%
DESIGN. SETTING, AND PARTICIPANTS We used data from a
2 0 0 5 -2 0 0 6 . Psychiatrists in the Midwest were more likely to
national survey o f office-based physicians in the United States
accept private noncapitated insurance (85.1%) than those in the
to calculate rates o f acceptance o f private noncapitated
Northeast (48.5%), South (43.0%), or West (57.8%) (P = .02).
[70.3%-75.5%],- P < .001) but had not declined significantly from
insurance, Medicare, and Medicaid by psychiatrists vs physicians in oth er specialties and to compare characteristics o f
CONCLUSIONS AND RELEVANCE Acceptance rates fo r all types
psychiatrists w h o accepted insurance and those w ho did not.
o f insurance were significantly lower fo r psychiatrists than for physicians in oth er specialties. These low rates o f acceptance
MAIN OUTCOMES AND MEASURES Our main outcom e variables
may pose a barrier to access to m ental health services.
were physician acceptance o f new patients w ith private
JAMA Psychiatry. 2014;71(2):176-181.
noncapitated insurance, Medicare, o r Medicaid. Our main
doi:10.1001/jamapsychiatry.2013.2862.
More than one-half o f individuals w ith a m ental illness do not re
o f psychiatrictreatm ent. A shortage o f psychiatrists participating in
ceive any mental health services.1Am ong those w ho perceive an un
insurance networks can result in long w a it tim es fo r an intake ap
m et need fo r m ental health services, financial concerns represent
po in tm e n t or an inability to find an in -ne tw o rk psychiatrist th a t ac
im portant barriers to care.1The im plem entation o f the Mental Health
cepts new patients. Patients w ho rely on o u t-o f-ne tw o rk psychia
Parity and A ddiction Equity A ct (MHPAEA) and th e A ffordable Care
trists fo r tre a tm e n t incur higher out-of-pocket costs due to higher
A ct (ACA) w ill p o te n tia lly reduce cost-related barriers to m ental
deductibles, copayments, coinsurance, and balance billing charges.3
health treatm ent by im provingthe level o f coverage for mental health
The low rate o f psychiatrist participation in health insurance net
services am ong those w ith health insurance and by expanding in
works is especially acute in th e Medicaid program, which is th e larg
surance coverage to previously uninsured populations.
est payer o f m ental health services in th e United States and dispro
In JAMA Psychiatry, Bishop e t al2 re p o rt results from th e Na
p o rtio n a te ly serves those w ith th e m ost disabling m ental health
tional Am bulatory Medical Care Survey showing low acceptance rates
disorders, such as schizophrenia.1 Bishop e t al2 found th a t slightly
fo r noncapitated insurance by psychiatrists. Bishop e t al found th a t
more than 4 o f 10 psychiatrists (43.1%) accepted Medicaid in 2 0 0 9 -
in 2 0 0 9 -2 0 1 0 , a low er percentage o f office-based psychiatrists ac
2010; o n ly d e rm a to lo gists had a lo w e r rate o f M edicaid accep
cepted private health insurance (55.3%) compared w ith other office-
tance. States th a t o p t into the ACA's Medicaid expansion w ill expe
based specialist physicians (88.7% ). Moreover, the rate o f partici
rience an increase in the percentage o f residents w ith m ental health
p a tio n in health insurance n e tw o rks has declined fa ste r am ong
disorders covered by Medicaid and in th e num ber o f users o f m en
psychiatrists in recent years than am ong oth er specialists.
tal health services.4 These changes are likely to stress th e already
The relatively small num ber o f psychiatrists accepting insur
190
overburdened system o f Medicaid m ental health practitioners.
ance may underm ine th e ability o f th e MHPAEA and th e ACA to re
Several factors likely co n trib u te to psychiatrists' low participa
duce financial barriers and expand access to care fo r those in need
tio n in Medicaid and o ther health insurance networks. One possi-
JAMA January 13.2015 Volume 313, Number 2
jama.com
From The JAMA N etw ork Clinical Review & Education
bility involves the relative reim bursem ent rates fo r the types o f pro
mental health care? One strategy is to incentivize greater participa
c e d u re s fo r w h ic h p s y c h ia tris ts are c o m m o n ly re im b u r s e d -
tio n among th e existing w orkforce in insurance plans by increasing
p s y c h o th e r a p y a n d m e d ic a tio n m a n a g e m e n t. B e ca u se
reimbursement rates fo r psychiatric services. However, in many mar
psychotherapy can also be provided by master's-level therapists, re
kets, it w ould be very costly fo r health plans to raise reim burse
im bursem ent rates fo r psychotherapy visits are low er relative to
m ent rates to high enough levels th a t could compete w ith w hat psy
m edication managem ent visits. The relative difference between
ch ia trists can charge p a tie nts w h o pay o u t-o f-p o cke t. A n o th e r
these reim bursem ent rates incentivizes psychiatrists w ho accept
approach is to increase the size o f the psychiatry workforce. H ow
health insurance to focus on m edication management visits.5 For
ever, this w ould take many years to im plem ent because o f the tim e
m any psychiatrists, however, a practice consisting o n ly o f tim e-
involved in training specialist physicians. Moreover, a larger w ork
lim ited m edication managem ent visits may be personally u n fu lfill
force may not increase the num ber o f psychiatrists w ho locate their
ing and at odds w ith th e ir values about how to practice good psy
practices in underserved areas or w ho accept health insurance.
chiatry. The coordination o f care w ith other clinicians and the delivery
A th ird approach, and potentially the most promising, is to fu r
o f culturally com petent, patient-centered care may require more
ther develop collaborative chronic care models (CCMs), which im ple
tim e than th e 10 to 15 minutes typically allotted fo r medication man
m ent team-based approaches to provide stepped care for those w ith
agement visits by insurance plans.
m ental illnesses and o ther chronic conditions.9 These models rely
The small size o f psychiatry practices may also co n trib u te to
on prim ary care clinicians to provide trea tm e nt fo r m ild to m oder
psychiatrists' low participation in health insurance networks. More
ate mental health disorders w ith support from case managers and
than half o f office-based psychiatrists have solo practices,2 which
consultation from m ental health specialists. Chronic care models
has substantial consequences fo r administrative costs among those
make e fficient use o f psychiatrists' tim e by enabling them to pro
w ho accept health insurance. The tim e required to negotiate con
vide decision support fo r prim ary care teams and direct treatm ent
tracts w ith insurance companies, file prior authorization forms, file
for patients w ith the most complex psychiatric needs. However, there
claims, and recover payments fo r services requires additional staff
are a num ber o f barriers to wide dissemination o f CCMs, such as lim
and a concom itant increase in office space. The revenue associated
ited fle x ib ility in reim bursem ent m echanism s to su p p o rt team -
w ith participation in insurance netw orks may n o t be sufficient to
based care, lim ited resources available to train participating physi
offset these additional overhead expenses fo r psychiatrists in solo
cians, and lim ite d in te g ra tio n o f health in fo rm a tio n te ch no lo g y
practices.
systems among comm unity-based clinicians to facilitate sharing o f
The overall shortage o f psychiatrists is a th ird fa cto r p o te n
patient medical records. By offering opportunities to develop infra
tia lly co n trib u tin g to low participation in insurance networks. Be
structures such as accountable care organizations fo r Medicare en-
cause more than three-quarters o f US counties have a severe sh o rt
roliees and medical homes fo r Medicaid enrollees w ith "serious and
age o f p s y c h ia tris ts ,6 th e a b sence o f c o m p e titio n can g ive
persistent mental illness," th e ACA m ight reduce these barriers for
psychiatrists the fle xib ility to choose how th e y w ant to practice and
ta rg e t populations and fa cilita te im p lem entation o f team-based
can facilitate the developm ent o f practices com prising exclusively
stepped-care approaches to m ental health treatm ent.
clients w ho can pay out-of-pocket. Supply-side trends also suggest
Recent federal laws th a t expand health insurance coverage for
th a tth e shortage may worsen in comingyears. The number o f gradu
mental health services have the potential to improve access to trea t
ates from psychiatry residency programs declined 14% between aca
m ent. If low rates o f psychiatrist p a rticip a tio n in insurance n e t
dem ic years 2 0 0 0 -2 0 0 1 and 2 0 0 7 -2 0 0 8 ,7 and the num ber o f psy
works persist, health care delivery models th a t make e fficient use
chiatrists has not kept pace w ith population g ro w th .8
o f psychiatrists'tim e am ongthose who do participate w ill be needed.
Given th e declining participation rate o f psychiatrists in insur
F urther de ve lo pm e n t and dissem ination o f collaborative team -
ance plans, how can health care delivery systems be m odified to en
based approaches offer one mechanism to m eet the needs for m en
sure th a t health insurance expansions result in im proved access to
tal health trea tm e nt in th e United States.
ARTICLE INFORMATION
REFERENCES
Author Affiliation: Department o f Health Policy
1. Behavioral health. United States, 2012 [HHS
and Management, Rollins School o f Public Health,
publication (SMA) 13-4797], http://www.samhsa
Emory University. Atlanta, Georgia.
.gov/data/sites/default/files/2012-BHUS.pdf. Accessed December 5,2014.
Corresponding Author: Janet R. Cummings, PhD, Department o f Health Policy and Management, Rollins School o f Public Health, Emory University,
2 . Bishop TF, Press MJ, Keyhani S, Pincus HA. Acceptance o f insurance by psychiatrists and the implications fo r access to mental health care. JAMA
6. Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP. County-level estimates o f mental health professional shortage in the United States. PsychiatrServ. 2009;60(10):1323-1328.
7. Faulkner LR, Juul D, Andrade NN, et al. Recent trends in American Board o f Psychiatry and Neurology psychiatric subspecialties. Acad Psychiatry. 2011;35(1):35-39.
1518 Clifton Rd NE, Room 650, Atlanta. GA 30322 ([email protected]).
Psychiatry. 2014;71(2):176-181.
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for
3. Kyanko KA, Busch SH. The out-of-network benefit: problems and policy solutions. Inquiry.
Disclosure o f Potential Conflicts o f Interest and none were reported.
2012-2013;49(4):352-361.
BHW0RK/PEP13-RTC-BHW0RK.pdf. Accessed December 5,2014.
Funding/Support: This work was supported by the
4. Garfield RL, Zuvekas SH, Lave JR, Donohue JM. The impact o f national health care reform on adults
9 . Woltmann E, Grogan-Kaylor A, Perron B, et al.
National Institute o f Mental Health (K01MH095823).
w ith severe mental disorders. Am J Psychiatry. 2011: 168(5):486-494.
Comparative effectiveness o f collaborative chronic care models for mental health conditions across
Role of the Funder/Sponsor: The funding source
5 . Harris G. Talk doesn't pay, so psychiatry turns
primary, specialty, and behavioral health care settings. Am J Psychiatry. 2012:169(8):790-804.
had no role in the preparation, review, or approval o f the manuscript.
instead to drug therapy. New York Times. March 5, 201TA1.
jama.com
8. Report to Congress on the nation's substance abuse and mental health workforce issues. http://store.samhsa.gov/shin/content//PEP13-RTC-
JAMA
January 13,2015
Volume 313, Number 2
191
Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
