6 Key Payer Benefits that Support Behavioral Health Prevention
Along with a strong provider network, payers can use these six strategies to promote behavioral health prevention.
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- With behavioral healthcare demands on the rise, payers must not only be aware of the current trends but establish pathways toward behavioral health prevention through their health benefits.
Half of employer-sponsored health plan enrollees with a high level of behavioral healthcare needs were categorized into cohorts of individuals with lower behavioral healthcare needs, a McKinsey & Company study found. Many individuals with a strong need for behavioral healthcare benefits are outside of the cohorts that receive the most support.
“Instead of waiting until people reach the point of crisis, we can take a holistic approach across all populations from screening and preventative care to more intensive services for patients with serious mental illnesses and substance use disorders,” the researchers concluded.
By covering screenings, care management, substance abuse prevention and education, peer support, wellness programming, and pediatric behavioral health, payers can move from reacting to serious behavioral healthcare diagnoses to preventing them.
Screenings
Screenings are a key preventive measure for behavioral health needs and a strategy that payers can easily implement.
Health insurers may base screenings on a variety of resources including the American Psychiatric Association (APA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Psychological Association (APA), or the Healthcare Effectiveness Data and Information Set (HEDIS) measures.
One evidence-based screening method that payers can promote is the Screening, Brief Intervention and Referral to Treatment (SBIRT). The tool is supported by SAMHSA. With this screening, providers can assess whether an individual’s substance use is risky. It is versatile, capable of being implemented by various types of providers in a wide range of settings.
Some payers also provide access to self-service screening tools. Payers who develop or give access to such resources should ensure that these tools use language that is easily comprehensible for patients with low healthcare literacy. They should also provide clear next steps for patients to follow when a screening indicates that they might have a behavioral health condition.
Care management
Care management is an important tool for catching conditions early in their development.
For example, public payers have implemented the Collaborative Care Model, which incorporates a behavioral care manager and a psychiatric consultant into the primary care team to better incorporate physical and behavioral healthcare. This model serves patients who have already been diagnosed with a condition that is less complex.
The model has proven effective for catching anxiety, depression, substance use disorders, and post-traumatic stress disorder (PTSD) early in their development. However, it is important to note that providers have cited various issues with this approach, including burdensome reporting requirements, workforce shortages restricting implementation, and low reimbursement combined with low uptake among payers.
Although it is not preventive initially, the model could reduce the risk of a mild or moderate condition developing into a serious condition.
Substance abuse prevention, education
Substance abuse prevention strategies can be broken down into three categories: universal preventive interventions, selective preventive interventions, and indicated preventive interventions. Payers might consider covering educational and early intervention efforts to protect their members from substance use disorders.
Universal interventions target a general group. Selective interventions aim to educate a population that is known to be at risk. And indicative preventive interventions serve individuals who have already demonstrated signs of substance abuse, although they might not have been diagnosed.
Many early intervention and educational programs for substance use disorders focus their efforts on young people.
More than a third of young adults reported that the most effective form of substance education involved learning about the long-term consequences of substance abuse, American Addiction Centers uncovered in a study of 500 students between the ages of 18 and 24. Despite this, over four out of ten participants stated that they did not receive any education on the science of addiction.
However, young people are not the only population that can benefit from targeted interventions. For example, workplaces could be an appropriate space for adult substance use disorder education and payers could also target populations of patients with chronic diseases.
Peer support groups
Peer support has been particularly important for underserved groups and is a well-recognized tool among national mental and behavioral health organizations. For example, Mental Health America’s resource page for peer support for behavioral healthcare highlights peer support opportunities for LGBTQ+ communities and Black, Indigenous, and People of Color (BIPOC).
Groups like Black Voices: Pathways 4 Recovery (BV) offer evidence for how peer support can help people of color with behavioral health needs connect and process their unique, challenging experiences. Feelings that might never come up in a therapy session for fear of being dismissed were freely expressed in a setting with others who could empathize from a personal perspective.
Studies have shown that peer support may be crucial for lesbian, gay, and bisexual young people. Research indicates that this tool can help reduce the adverse psychological effects of family rejection after a young person comes out by offering communal support. Peer support training has also helped youth in the LGBTQ+ community be prepared for mental health crises.
Some payers have partnered with healthcare organizations to cover peer support. While many of these programs are designed for disease management, some lend themselves to behavioral health prevention.
For example, Blue Shield of California’s Blue Sky initiative funded a National Alliance on Mental Illness (NAMI) program, On Campus High School (On Campus). On Campus groups are peer-led support groups for teenagers who may have a diagnosed mental or behavioral health condition, have a family member with a diagnosis, or who are interested in advocating for mental and behavioral health.
Programs like On Campus can improve young adults’ understanding of mental and behavioral health conditions and combat isolation, preventing loneliness from accelerating the development of behavioral health conditions.
Wellness programs
Factors outside of mental health or clinical conditions can affect behavioral health, including physical wellness. Addressing these factors can support behavioral health prevention.
Payers can promote physical wellness by creating effective wellness programs. There are five domains in wellness programming: financial or economic, physical, environmental, emotional, and social. By enabling members to set goals and track progress in these areas, payers can help them avoid serious conditions and catch behavioral health diagnoses early.
What makes a wellness program effective is a hotly debated subject. Employers who partner with their employees to create wellness programs may see better success.
Additionally, employers have found three elements of a successful wellness program. Effective programs combine digital and on-site engagement. Additionally, they use social determinants of health data as a compass when selecting goals and benefits. Lastly, they promote health equity.
Payers are giving members more freedom in defining fitness. When UnitedHealthcare redesigned its wellness programming approach, executives underscored the importance of giving their members choices. Additionally, the insurer changed its strategy around rewards, making it simpler to access rewards and increasing their value.
Pediatric behavioral health
While it is still too early to fully comprehend the impact of the coronavirus pandemic on children’s health, experts expect that the disruption to children’s normal routines and the uncertainty of that timeframe have had significant effects on physical, mental, and behavioral healthcare trends.
Payers can offer benefits that specifically target pediatric behavioral health conditions in order to stem the behavioral health epidemic in this population and prevent these occurrences from developing into more serious conditions later in life.
Important preventive benefits might include partnering with schools to facilitate educational opportunities, care management for children and adolescents who are at risk of suicide, facilitating access to screening materials for pediatricians, covering telebehavioral healthcare, and ensuring that their caregivers have access to therapy.
Most health plans also cover a number of mental and behavioral screenings for children. These look for signs of a variety of conditions across five age ranges.
These six benefits are not comprehensive. They should be supported by a strong behavioral healthcare provider network and access to mental health benefits, among other core behavioral health prevention strategies. But by implementing these six benefits, insurers may be able to reduce behavioral health risks among their member populations and promote healthier communities.
