Employers set to expand mental health coverage by 2023

Employers improved their mental health and wellness benefits for employees during the COVID-19 pandemic and are poised to continue expanding those offerings in 2023, new research shows. Still, many employees have challenges accessing care.

Survey results released in August by AHIP, a trade association of health insurers formerly known as American Health Insurance Plans, highlight how health plans are improving access to mental health services (also called behavioral health) by bringing more high-quality providers into their networks and helping patients find available mental health appointments.

“Even before the COVID-19 pandemic, millions of Americans were struggling with mental health and substance use issues,” said Kate Berry, senior vice president of clinical affairs and strategic partnerships at AHIP, based in in Washington, DC “The mismatch between the supply of mental health and substance use disorder providers and the demand for care is a long-standing problem. That’s why health insurance providers are working hard to improve their provider networks and increase access to care.”

When health care providers offer plans with a wide selection of in-network mental health professionals, effective mental health support is more accessible and affordable, Berry said.

AHIP released the survey in May and June of its members who offer health plans in the employer-sponsored group marketplace, both self-insured plans that employers design with third-party administrators and fully insured plans purchased from insurance companies. insurance

“More than half of Americans—nearly 180 million—have employer-provided coverage for their health care needs, providing an essential pathway to accessing much-needed mental health support,” he reported. AHIP.

The survey also included plans sold in the individual market, such as those purchased on an Affordable Care Act market exchange.

Based on responses from plan administrators representing 95 million enrollees, the survey found that:

  • All respondents offered some telehealth coverage for mental health services.
  • The number of behavioral health providers in the network that offer health plans grew an average of 48 percent in three years.
  • The vast majority of health plans (89%) are actively recruiting mental health care providers, including professionals who reflect the diversity of the people they serve (83%), and 78% have increased payments to providers in efforts to recruit more high-quality professionals in their plan networks.
  • The number of providers eligible to prescribe medication-assisted therapy (MAT) for substance use disorder, including opioid dependence, has more than doubled, growing 114 percent in three years.

Facilitate access to care

A large majority (83%) of plans reported that they help enrollees find available mental health appointments. In addition, 78 percent use specialized case managers for follow-up after emergency room and hospital care or to initiate new medications.

“Health insurance providers are taking steps to improve mental health care by proactively identifying the behavioral health needs of their members, collaborating with providers and reducing stigma,” said Berry . “While much work has been done, health insurance providers recognize the need to address systemic challenges. This can only be achieved with all healthcare stakeholders working collaboratively to ensure that Americans have affordable access to the high-quality mental health support they deserve.”

Many therapists, however, prefer to remain outside the insurance system and collect payment directly from their patients, limiting access to those with lower incomes and limited savings. For example, the Manhattan Therapy Collective, a mental health practice in New York City, chose to remain an out-of-network provider because insurers “compensate therapists on a very delayed schedule (if any) and at below-market rates,” and they can limit the number of sessions they’ll pay for per year, according to their website.

Other therapists may only offer a certain number of slots to those who cannot pay out of pocket, according to the professionals’ website psychology.org. One way to improve the situation is through telehealth, as virtual appointments increase the number of therapy options available to patients and can reduce costs for professionals, who may not have to pay for space. office, the website noted.

A gender divide

Women overwhelmingly value mental health benefits compared to men (70 percent compared to 49 percent), according to a recent report from benefits technology firm PeopleKeep. The finding comes from a May 2022 survey of more than 900 employees at small and medium-sized businesses.

“As employers consider their benefits offerings, they should recognize that priorities are sometimes different based on demographics,” said Victoria Glickman Hodgkins, CEO of PeopleKeep.

The fact that men do not value mental health benefits as much is a challenge for mental health providers. “From an early age, boys are often told to be strong and independent, keeping their emotions and thoughts to themselves,” Siddharth K. Shah, a psychiatrist in Orlando, Florida, wrote last November . “This belief has far-reaching consequences,” he added.

“In the United States, men are 3.6 times more likely to die by suicide than women,” Shah noted. “Higher risk of suicide is associated with men being less likely to seek help for mental health struggles.”

These concerns are shared by Rob Whitley, associate professor in the Department of Psychiatry at McGill University in Montreal. Writing in Psychology today last year, it encouraged employers and public health providers to increase their outreach efforts targeting men, including:

  • Offer mental health literacy programs in workplaces and elsewhere to improve understanding of mental health.
  • Guarantee equal treatment of mental and physical health problems in the workplaces, which are discussed in the following table.

Guaranteeing parity in mental health

The Mental Health and Addiction Equity Act (MHPAEA) became law in 2008, but did not “give teeth” until Congress passed the Consolidated Accreditation Act of 2021, which mandated employers to assess their compliance with the MHPAEA and ensure they provide equal coverage limits for mental health/substance use disorder benefits and medical/surgical benefits.

Last April, the Department of Labor issued guidance to help plan sponsors and administrators meet the heightened compliance requirements.

Employers, as health plan fiduciaries, “are responsible for making sure vendors get their act together and follow through on [on mental health parity requirements]or if not, employers are to blame,” said Jay Kirschbaum, director of benefits compliance and senior vice president at Washington, D.C.-based World Insurance Associates, speaking earlier this year at the SHRM Labor Law and Compliance 2022. “It is your responsibility to ensure that your issuers or vendors are in compliance.”

Racial barriers

“Racial and ethnic minorities often suffer poor mental health outcomes due to cultural stigma and lack of access to mental health care services,” according to the Department of Health and Services’ Office of Minority Health In addition, many historically marginalized groups face barriers to accessing needed mental health care, a problem exacerbated by the lack of racial and ethnic diversity among mental health professionals.

“Black and African-American providers, who are known to provide more appropriate and effective care to Black and African-American help-seekers, make up a very small portion of the behavioral health provider workforce,” according to Mental Health America (MHA), a non-profit that addresses the needs of people living with mental illness.

Because nonwhite racial and ethnic groups are underrepresented among members of the American Psychological Association, “some may worry that mental health professionals are not culturally competent enough to treat their specific problems,” she said. say MHA

The group pointed to the following statistics from the US Centers for Disease Control and Prevention:

  • 58 percent of young black adults between the ages of 18 and 25 and 50.1 percent of black adults ages 26-49 with serious mental illness did not receive treatment (as of 2018).
  • Almost 90 percent of blacks over the age of 12 with a substance use disorder did not receive treatment.

Because of barriers to treatment, “Black and African American people are more likely to experience chronic, persistent, rather than episodic, mental health conditions,” according to MHA.

Progress will be made to overcome these challenges “as light is shed on these issues, and the general public prompts policy makers and health systems to evolve better systems. [that] eliminate inequalities in mental health services,” the group said.

According to HR consultants Mercer, “virtual behavioral health care may provide better access to marginalized groups due to its convenience, timeliness, and affordability compared to in-person visits.”

They advise employers to focus on keeping telehealth therapy services “affordable to encourage use in the most vulnerable and high-risk populations.”

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