Behavioral Healthcare Parity Is Low Among Regional, State Plans
Payers of all types did not perform perfectly on behavioral healthcare parity, but regional and state health plans demonstrated low compliance and high out-of-network utilization.
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- Although the coronavirus pandemic has imposed significant changes on the healthcare industry particularly in regards to behavioral and mental healthcare, historically behavioral healthcare parity has not been a priority for payers and, as a result, compliance, network adequacy, and use of value-based payments are all low, according to an Avalere survey.
The survey covered 37 decision-makers in healthcare organizations that included payers, behavioral health management organizations, and integrated delivery networks.
“Behavioral health did not emerge as a top management priority or area of organizational expenditure, indicating opportunity for greater attention,” the researchers noted. “However, the impact of the COVID-19 PHE on plan member mental health needs and utilization may increase attention and management effort in upcoming plan years.”
Payers evaded certain requirements such as assessing behavioral healthcare network adequacy. Legally, payers have to conduct an assessment that covers various adequacy indicators from wait times to out-of-network utilization. Eight out of ten survey participants had conducted an analysis of their network adequacy.
Among regional or state health plans and behavioral health benefit management organizations, the rates of compliance on this issue were especially low. Nearly four in ten regional or state health plans reported that they did not conduct the assessment (38 percent).
In contrast, 100 percent of integrated health systems complied as did 94 percent of national health plans.
More than half of all survey participants (54 percent) reported that they had estimated a significant amount of out-of-network care utilization in behavioral healthcare. Regional and state health plans were most likely (62 percent) to cite significant out-of-network behavioral healthcare utilization, followed by national health plans (59 percent).
“Surveyed plans recognized the need to expand behavioral health provider networks and indicated ongoing efforts to recruit additional providers. However, a national shortage of behavioral healthcare providers may be limiting network expansion efforts,” the survey acknowledged.
When it came to value-based payment utilization, only a third of respondents stated that they were using value-based care models to reimburse for behavioral healthcare.
Among that third of the survey population, the most common strategy was to use an alternative payment model based on fee-for-service reimbursement with shared savings or shared risk. The popularity of this approach was nearly matched by models that tied fee-for-service payment to quality of care and value.
However, respondents indicated that changes were on the horizon. Three-quarters of the survey participants stated that they expected to increase behavioral healthcare reimbursement rates by six percent or more in the future. The same quantity of participants anticipated that they would expand their behavioral telehealth services.
Additionally, although current rates of value-based care use were low in the behavioral healthcare space, nearly six in ten plans stated that they were interested in introducing behavioral healthcare alternative payment models.
The results align with experts’ findings before the coronavirus pandemic. Henry Harbin, MD, a psychiatrist and an advisor to The Bowman Family Foundation, confirmed to HealthPayerIntelligence that some health plans have rejected expanding their behavioral healthcare networks, even when providers are willing to take a pay cut for it.
In a separate conversation with HealthPayerIntelligence, Harbin recommended that payers conduct their own assessments of behavioral healthcare parity.
He suggested that the report should cover four data points: the percentage of out-of-network mental and behavioral healthcare claims, in-network reimbursement rates compared to medical care, the denial rates for these services, and network directory accuracy.
The burden does not lie on payers’ shoulders alone, however. Employers will also have to work to improve mental and behavioral healthcare. Encouraging preventive care, introducing collaborative care models, empowering employee assistance programs, and tracking member outcomes are key strategies to connecting members with needed behavioral healthcare services.
