Who ya gonna call? Ghost networks

Wednesday, October 4, 2023

By Courtney Wise

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How “ghost networks” make it tough to find a therapist

But a recent investigation from The Seattle Times revealed health care directories to be disorganized, hard to follow, and inflated with providers who are unavailable to offer care.

Under Washington law, insurance companies are supposed to maintain a sufficient network of health care providers to serve members of their plans to ensure that they can reasonably and efficiently access care. But a recent investigation from The Seattle Times revealed health care directories to be disorganized, hard to follow, and inflated with providers who are unavailable to offer care. 

After surveying lists of therapists from four of Washington state’s largest insurers, Premera Blue Cross, Regence BlueShield, UnitedHealthcare and Molina Healthcare, reporters reached out to 400 providers listed. They chose the top 50 results that appeared within each network when searching from different Seattle ZIP codes. What they found was distressing: Of 400 therapists, just 19 actually had availability for a general new patient. Moreover, many providers never responded to requests for appointments, later stating in interviews that they only return calls if they have availability.

“When someone who’s worried about their mental health or the mental health of a loved one finally works up the courage to pick up the phone and try and get help, the last thing they need is a symphony of ‘please hold’ music, non-working numbers, and rejection,” said U.S. Senator Ron Wyden (D-Oregon) in a Senate Finance Committee meeting on the matter.

Two years ago, Congress passed the No Surprises Act, requiring insurers to update provider directories once per quarter. Premera and Regence said they do just that in an effort to share accurate information, allowing providers to update their availability, locations and more via online forms, email, phone calls, mail or fax. The problem is that provider availability can change day to day, said licensed clinical psychologist Angela Agelopoulos, and the system insurers use isn’t practical for updates in real time. “You can’t simply call and talk to the people that you need,” she said. “By the time they put that information in, we don’t have that opening anymore.” She suggests insurers work together to create a database allowing therapists to update necessary information as it changes. 

It’s a problem Agelopoulos understands from both sides as the owner of her own practice, Seattle Counseling and Wellness, and a parent whose son has languished on a waitlist for specialized therapy the past two years. She calls every four months to check availability. “I love being a psychologist,” she said, “but I really hate insurance.”

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Blacks less likely to benefit from new Alzheimer’s drugs despite greater risk of developing the disease

Jessica Guthrie wants to hold on to her mother, Constance, for as long as she can. She’s labored in love over the past decade, providing her mother’s care and taking responsibility for her decision-making as Alzheimer’s disease progresses in her brain. Guthrie is always excited to hear of promising developments on the horizon. It’s why she told Capital B News she was initially hopeful about two new drugs that are said to slow progression of the disease – Leqembi, which is currently on the market, and donanemab, which is in late-stage clinical trials. But it turned out her mother’s disease is too far along for either drug.  “Oh hell,” she said after learning more about the research, “this isn’t for us.”

But her mother might not have been a good candidate for either drug at any point. Both medications work by seeking and removing amyloid, a toxic protein that forms clumps in the brains of many people with Alzheimers. Neither drug will cure or reverse the disease, but they are thought to slow its progress. But Black Americans were frequently screened out of studies for the drugs because too little amyloid was found in their brains to qualify, Reuters reported. Many Latinos were also screened out for the same reason, though not as frequently as Blacks.

But here’s the conundrum: Black people get Alzheimer’s at twice the rate of white people and Latinos get it at about one-and-a-half times as frequently. That suggests that it may not be amyloid that is causing the disease in Blacks and Latinos. (Indeed, the focus on amyloid is controversial; some scientists are skeptical that it’s the causative agent in anyone.)

 “If Black Americans don’t have enough amyloid to be in the trial, but they have a higher risk of the disease, shouldn’t we try to understand what is causing their disease and target whatever that is for clinical trials?” said Lisa Barnes, a cognitive neuropsychologist at Rush University Medical Center. “As a field, we need to figure out how to include people who are supposedly at higher risk of the disease.” 

Barnes says the fraught relationship between medical institutions and Black communities, rooted in racism and abuse, makes recruiting Black people for clinical trials difficult. But that shouldn’t be an excuse for low participation in clinical trials. Pharmaceutical companies and researchers must be held to a higher standard, said Carl V. Hill, chief diversity, equity, and inclusion officer for the Alzheimer’s Association. Scientists don’t know why rates of Alzheimer’s and dementia are so different across race, which means a lot more research is needed. “We certainly need to know more,” Hill said.

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On the streets of L.A.’s Skid Row with the Honorable David O. Carter

U.S. District Judge David O. Carter has an unconventional approach. He has been overseeing a landmark lawsuit against Los Angeles County for more than three years and last week, he signed a historic settlement that compels the county to do more to serve its unhoused population. But what makes the 79 year old stand out is his insistence on walking the streets of Skid Row to ensure the county keeps its promise.

Under the terms of the agreement, Los Angeles County must provide 3,000 new mental health and substance use treatment beds and dedicate hundreds of millions of dollars in social services and resources to house people who are homeless. The deal will save a lot of lives but won’t end homelessness, Carter said last week. It’s “a floor, not a ceiling.” To ensure the work is being done, the settlement also calls for a monitor, who “must be willing to take to the streets, and learn from the community, not the bureaucracy,” Carter wrote in the agreement. And on Friday, he played tour guide, taking the proposed monitor with him on a walk through Skid Row to meet those who will be impacted by the changes.

Carter’s intent, he told the Los Angeles Times, is to have the proposed monitor, retired U.S. Magistrate Judge Jay C. Gandhi, speak to Skid Row residents who can offer him insight and understanding about their needs. Along the way, they spoke with Kevin Call, who dubs himself the mayor of Skid Row. “LAHSA [the Los Angeles Homeless Services Authority], they drive around the streets; they don’t give up much to the people,” Call said. “Maybe they got a bag lunch, toothpaste and a soap, but they’re not doing what is necessary for the people.”

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In other news…

Skid Row Running Club: Speaking of Los Angeles judges with an unconventional approach, consider Craig Mitchell, a Superior Court felony trial judge. By day, minimum sentencing laws require him to issue harsh prison sentences to people he believes would be better served and redeemed with less time. But before work, he commits to offering others a path to health and hope with the Skid Row Running Club. Founded in 2012, its sole mission is to improve the lives of people in Los Angeles dealing with homelessness and addiction. Mitchell first spoke with HBO’s Real Sports in 2020. Last month, the show provided a heartwarming update. Catch the full segment on Max.

Five Asian wellness books that challenge conventional wisdom: It’s an annual ritual: Every January, Americans vow to lose weight and get healthy. In an interesting read from the beginning of this year, Cold Tea Reads published a list of books that defy the typical messages of Western diet and wellness culture, while also nurturing better habits and sound mental health. 

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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