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Payers, Purchasers Must Guarantee Mental Health Access Parity

Mental health access is essential to better patient care and outcomes, but few payers offer care access at the same rate as physical care access.

mental health access

Source: Thinkstock

By Sara Heath

- When compared to access opportunities for physical health treatment, mental health access leaves something to be desired, according to a recent report from the National Alliance of Healthcare Purchaser Coalitions. Healthcare payers and purchasers alike must do more to demand mental health access parity for patients.

Adequate treatment of certain conditions such as depression, anxiety, and other common mental health conditions can have a significant impact on the employee experience, the study suggested. Employers whose workers receive adequate mental healthcare tend to see higher productivity from those workers, making care access a key financial and quality-of-life benefit.

But it’s incumbent upon healthcare payers to ensure patients have enough access to mental healthcare, especially as it compares to physical health. The law currently mandates that healthcare payers offer equal access to mental healthcare and physical healthcare.

But that is not the case, the National Alliance stated.

“There's no question that our mental health system needs work and we're collaborating with key stakeholders and our network of member coalitions to broker real solutions for very serious issues,” Michael Thompson, president and CEO, National Alliance, said in a statement.

READ MORE: Integrating Mental Health and Primary Care to Achieve Zero Suicide

“Conditions like depression, anxiety and substance use disorders are prevalent among the US workforce and employers must ensure affordable and improved access to quality support for employees and their families,” Thompson added. “Parity is the law – and improved performance is good business.”

Due to a number of care access barriers and limited oversight, access to mental healthcare is falling by the wayside, the report found.

For one, there are far fewer in-network care options for mental health and substance use disorder treatments, data showed.

In looking at out-of-network claims for beneficiaries of eight common employer-sponsored plans, the researchers found that patients access out-of-network mental healthcare 13 percent of the time while patients only have to access physical healthcare out-of-network 5 percent of the time.

Because of the high costs associated with out-of-network care, these barriers may dissuade many patients from obtaining necessary treatment altogether.

READ MORE: Fragmented Mental Healthcare Stunts Patient Access to Care

Very few healthcare payers monitor access rates, either, the report found. Only one of the eight plans investigated have what was deemed adequate monitoring of wait times and access standards for mental and behavioral health, the report noted.

Health plans are also allowing mental and behavioral health screenings to fall by the wayside.

None of the plans require clinicians to monitor patient progress in mental health improvement. And while all plans record HEDIS measures for mental and behavioral health, few provide that data to providers to better track care quality and access.

Access to prescription medications for mental and behavioral health treatments is also left wanting, the report revealed. None of the health plans use adequate value-based formularies for prescriptions, allow for clinical judgement and genetic testing results in medication access, or monitor for appropriateness of ADHD medications or antidepressants.

Only one plan had adequate protocol for measuring beneficiary medication adherence. Similar findings emerged for access to medication-based opioid treatments.

READ MORE: Closing Mental Health Care Disparities by Targeting Cultural Needs

Two plans allowed access to personalized testing to better understand effectiveness of prescription medication and patient tolerance.

The researchers saw better results when looking at patient risk stratification and identification of clinical need. For example, all payers required adequate access to after-hours behavioral healthcare. Most payers also called for reimbursement of transitional care codes, comorbidity assessment, identification of behavioral health risk factors, and use of member data for wellness tracking.

All payers must improve access to behavioral and mental health provider directories, the report noted.

Although all of the payers use some sort of assessment to track access parity between mental and physical health, none of them adequately deploy a third-party analysis.

While healthcare payers must work to close these gaps and ensure equal access to mental and behavioral health, purchasers – in many cases, employer groups – must demand this of payers. Demand from a payer’s customer base is the first step toward improvement, the report suggested.

“Mental health conditions like depression, anxiety and substance use disorders will continue to be prevalent among covered populations, and employers need to ensure that they are delivering on the promise of parity with appropriate and affordable access to quality support that employees and their families need and deserve,” the researchers wrote in an accompanying action guide.

Employers can set expectations for payers, administrators, and other healthcare treatment vendors; use an independent review services to analyze mental and behavioral health coverage for different plan options; and continuously review in- and out-of-network care access to understand how beneficiaries interact with plan options.

Additionally, employers can be instrumental in driving a culture of behavioral health access. By understanding the effects of mental health access, discussing the importance of mental health, and promoting a culture of worker wellbeing, employers can foster mental health access among employees.

“In this era of escalating suicide rates and opioid overdose deaths, there is an urgent need for employers to appreciate the key role they play in ensuring that their employees and families have access to high quality mental health services and treatment,” Henry Harbin, MD, a psychiatrist, former CEO of Magellan Health Care, and noted expert on mental health parity, said in a statement about the report.

“Each employer has the power to act on the recommendations in this report to ensure people who seek help can get it, and that mental health and substance use disorders are treated the same way as physical health conditions by their plans and providers.”

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