A federal watchdog has determined that most of the mental health provider listings in Tricare network directories are inaccurate or outdated, a problem that could prevent military service members and families from getting vital behavioral health care.
The Government Accountability Office estimated that 85% of listings in the Tricare East Region and 79% in the Tricare West Region had troubles with location, gender of the provider, specialty or subspecialty descriptions, or phone and fax numbers.
Such details are necessary for Tricare beneficiaries to find in-network psychiatrists, psychologists and therapists, according to the report released Monday.
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"Network provider directories are helpful tools that health plan beneficiaries can use to search for providers available to them in their network, by location, and by provider specialty -- including behavioral health providers," noted the report. "Directory inaccuracies are likely to impair beneficiaries' search for behavioral health care from providers that accept Tricare."
Demand for mental health services has risen dramatically within the military health system and the Tricare health program, with mental health diagnoses quadrupling among service members and increasing six-fold among their children in the past two decades.
Combat exposure, long work hours, deployments, frequent moves and other stressors of military life likely contribute to that rise, according to the report.
The increase also reflects nationwide increased demand for mental health services. According to Mental Health America, a nonprofit behavioral health awareness and advocacy group, 21% of American adults have a behavioral health condition and one-third say they have trouble accessing care.
"Due to the widely reported shortages of behavioral health providers, finding these providers can be a significant hardship for beneficiaries -- including service members and their families who are increasingly in need of behavioral health care, and who move frequently, therefore requiring new providers in different locations," GAO officials wrote.
Under the current Tricare contract, the network providers -- Humana Military in the East Region and Health Net Federal Services in the West -- must maintain provider locator databases that meet a 95% threshold for accuracy.
Overall, Health Net Federal Services' directory for all providers was 81% accurate and Humana's was 83% accurate this year, according to an overall assessment referenced in the report.
The Defense Health Agency does not track accuracy by specialty nor do the contractors, who are not required by the contract to do so. DHA officials told the GAO they don't track at the specialty level because they did not think there would be any differences in accuracy by category.
To assess for errors, GAO analysts made covert calls to 342 behavioral health providers listed in the Tricare East and West provider directories and, based on those results, estimated the accuracy rates.
According to the GAO, the East and West Region directories contain 130,000 listings for 78,000 mental health providers, with multiple listings for those who see patients in different locations.
Such high levels of inaccuracy in network search engines aren't unique to Tricare, according to the GAO. The report noted discrepancies in directories for private insurance companies, Medicare Advantage and the Department of Veterans Affairs.
"These providers often have to provide updated information to multiple health plans and multiple systems; therefore, the task can be challenging," GAO analysts wrote.
In a separate section of the report, the GAO analyzed portions of a 2023 Defense Health Agency survey of providers to determine why they don't join the Tricare network and serve military personnel and families.
According to the report, low reimbursement rates from Tricare dissuade providers from joining, especially in fields where quality, in-demand providers can sidestep insurance companies and take only patients who can pay out-of-pocket. Burnout and a lack of awareness about Tricare also contributes, the report noted.
The GAO made two recommendations to the Defense Department to improve the behavioral health provider databases: First, the Defense Health Agency should assess the accuracy of the listings and aim to bring accuracy rates up to the level of accuracy for entire provider databases, and it should address the cause of the inaccuracies.
And second, it also recommended that the DHA periodically monitor the mental health provider listings for accuracy.
In a response to the recommendations, Defense Health Agency officials said they would consider whether they could require Tricare contractors to review the behavioral health directory listings.
But they disagreed with portions of the first as well as the second recommendation, saying they lacked the staff to monitor for accuracy and such requirements were not in the next generation of Tricare contracts. It also would be too complex to monitor the databases given the fluidity of the provider networks, DHA officials argued.
"Due to the variability of providers, the availability of administrative support, the availability of the providers themselves and the increased mobility of behavioral health providers, DoD cannot ensure accuracy rates are comparable to the overall directory," wrote DHA Director Lt. Gen. Telita Crosland.
In statements to Military.com, both Health Net Federal Services and Humana said they strive to ensure accuracy in their directories, working with the Defense Department and the providers to maintain updated information.
"The challenges of maintaining an accurate behavioral health directory are described in the report and reinforce a well-documented, industry-wide concern," said Nicole Hebert, director of insurance services communications for Humana. "Humana Military's goal is to continue to work alongside [the] Department of Defense to improve directory accuracy for this specific population of providers."
Hebert added that beneficiaries can reach out directly to Humana if they have trouble locating providers.
"The Humana Military contact center is available to assist in finding a primary or specialty care provider to ensure they get the care they need when they need it," Hebert said.
In a statement, Health Net Federal Services said it conducts monthly audits of provider records, including behavioral health providers, and reviews all pertinent information, finding that the directory accuracy score is consistently above 80% each month.
"As the manager of Tricare's civilian provider network in the West Region, Health Net Federal Services (HNFS) proactively works with our network providers to obtain timely, accurate directory data," the company said.
Editor's note: This story has been updated to include comments from the Tricare regional contractors.
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