Employer Strategies For Responding to the Mental Health Crisis

April 12, 2021 - Most healthcare stakeholders can perceive the impacts of the escalating behavioral and mental healthcare crisis on their own industry segment, but employers have a particularly proximate perspective.

“As an employer coalition, we are the real payers of healthcare,” Cheryl Larson, president and chief executive officer of the Midwest Business Group on Health (MBGH), emphasized to HealthPayerIntelligence. “It's not insurers and PBMs. It's primarily self-insured public and private employers, and of course, the insurer or carrier payers are managing the fully-insured companies.”

With that level of responsibility, employers cannot ignore the mental and behavioral healthcare epidemic that is plaguing their employees.

Over seven in ten employees say that they feel burned out, according to a Limeade survey. Slightly more than half of the non-managerial workers do not sense that their employers have an authentic concern for their well-being. Managers say that they shoulder the blame for employee burnout but also report feeling overworked themselves.

Reed Hartley, executive director at Thought Leadership & Innovation Foundation (TLI), and the TLI staff were familiar with this problem and proposed a pathway to stronger employee mental health for MBGH’s member companies. Part of TLI’s mission is to bring together stakeholders in healthcare to develop solutions that will improve member outcomes.

READ MORE: Payer Seeks to Balance In-Person, Virtual Mental Healthcare

Together, Larson and her team at MBGH and Hartley and the TLI staff aimed to improve access to mental healthcare in Illinois.

Although regions and companies require tailored solutions to any major problem, TLI starts with the same overall approach, complicated by the range of stakeholders involved and, in this case, the nuances of mental and behavioral healthcare itself.

“The first thing we do is we bring together a variety of stakeholders in the community so that we are getting a variety of perspectives to come toward a common vision, which is how can we focus either on helping specific patient populations or specific issues,” Hartley explained to HealthPayerIntelligence.

In Illinois, MBGH and TLI will be rallying stakeholders around mental healthcare for their Community Collaborative.

“Then, through collaborative meetings, we try to identify some pilots or some programs that we can go out and either succeed small or fail small,” Hartley continued. “We don't expect every one of those to necessarily be successful, but to innovate in trying some new approaches.”

READ MORE: 2 Mistakes Payers Can Avoid in Mental, Behavioral Health Screenings

The results for Illinois will be specific to the needs identified by the stakeholders in that state. Hartley and Larson could not predict what the final strategy will be.

However, there were some overarching themes that employers had articulated to them in regards to improving mental and behavioral health benefits.

Preventive care

Preventive care is a common method that employers leverage to address mental healthcare in the workplace.

“Preventive care and early diagnosis are important in all areas of healthcare, but it's especially important in mental health,” Hartley argued. "Everybody benefits from that. Patients benefit from that, employers benefit by having healthier and happier employees, the community benefits from that.”

In an Optum survey, 43 percent of employers reported that they offered preventive care as well as financial and behavioral healthcare resources. Another four in ten employer respondents (38 percent) were in the process of implementing these types of resources.

READ MORE: 4 Ways Payers Can Invest In Mental and Behavioral Healthcare

The coronavirus pandemic underscored the need for greater preventive care by heightening the nation’s mental and behavioral healthcare crisis.

Millennials with behavioral health conditions are twice as likely to develop chronic diseases such as coronary artery disease, type 2 diabetes, and hypertension, according to a Blue Cross Blue Shield Association report.

However, Millennials are unlikely to have a primary care provider to coordinate their care. It is critical, therefore, that payers focus on connecting members with a primary care physician as a pathway to engaging them in preventive services.

Collaborative care models

Collaborative care is a central component of this discussion, Hartley indicated.

“Too often in underserved communities, the very first mental health interaction somebody has is with law enforcement. We've seen some of the tragic consequences of that because law enforcement is not trained to handle mental health situations,” said Hartley.

“So there are a lot of collaborative care discussions and innovations that we can look at. Nobody has really solved that puzzle or put it together completely yet because it requires so many stakeholders to work together.”

Collaborative care models often hinge on having a primary care provider or care manager who can help identify mental and behavioral health needs and oversee their patients’ treatment schedules.

According to the American Psychiatric Association’s (APA’s) Center for Workplace Health, collaborative care is more cost-effective than typical care patterns. It can result in savings of $1,815 per employee per year. Additionally, employees may be more productive and national healthcare spending could decrease.

Employers may choose to pursue this strategy through an employee assistance program.

Employee assistance programs

Employers are also bolstering their employee assistance programs (EAP) in order to better support their employees’ mental health needs.

“EAPs have evolved into being much more than just answering the phone or sending you to a provider,” Larson explained.

Major organizations that promote behavioral and mental healthcare have supported leveraging EAPs to better integrate mental healthcare into the workplace and address employees’ needs.

The Substance Abuse and Mental Health Services Administration (SAMHSA), which falls under the US Department of Health and Human Services (HHS), advocated for employers to design their EAPs to offer substance abuse care.

SAMHSA noted that there are multiple designs for an EAP that could fit this goal. The organization offered a list of questions to help guide employers to the right model for their substance abuse support EAPs, including questions to ask their EAP provider.

Mental Health America (MHA), one of the nation’s leading community-based nonprofits focused on mental healthcare, noted that EAPs can generate a $3 to $10 return on investment for every dollar spent on the programs.

However, MHA added that, although EAPs are prevalent particularly in larger companies, employee utilization is low. MHA attributed this primarily to misconceptions about privacy and employees’ fears that their personal experiences will be tied back to them.

MHA recommended clearly communicating the benefits of EAPs to employees—both when they start their positions and throughout their careers at their companies—and should emphasize the fact that EAP communications are confidential. Mid-level managers can play a positive role in directing employees to the EAP when they need it.

The APA has also supported the EAP approach, underscoring the variety of issues that EAPs can address and methods that these programs can use to engage with employees.

Tracking member outcomes

Employers have also started pushing beyond the CDC guidelines to better measure member outcomes for behavioral and mental healthcare.

In the past, employers could “check the box for parity” without knowing whether employees were seeing positive outcomes, Larson explained.

In a recent survey conducted for MBGH, participants were asked whether they were tracking the outcomes to there mental and behavioral healthcare parity strategies. Many respondents answered that they were not, Larson noted.

“The pandemic is giving us a unique opportunity. Not only have we ramped up efforts because they were needed, but we're also looking at the design, looking at making sure that it's beyond just the basic information,” said Larson.

Improving quality measurement in behavioral and mental healthcare is part of the solution put forward by the PATH Forward Initiative. The National Alliance of Healthcare Purchaser Coalitions began the PATH Forward Initiative along with other stakeholders to tackle mental and behavioral healthcare.

In a brief promoting integrated behavioral and mental healthcare services, the initiative recommended that employers make it a requirement that their insurers inform them about the results of relevant programs.

“Require ongoing reports showing data measuring utilization/outcomes of integrative medical and mental health services,” the brief urged.

Employers have also been seeking more transparency from insurers around payment parity related to mental and behavioral healthcare.

Specifically, experts have identified four data points that insurers should analyze in order to ensure parity: percentage of allowed inpatient and outpatient out-of-network claims, in-network reimbursement rates, how often they refuse coverage for a behavioral or mental healthcare request, and network directory accuracy.

“We would like to see more health plans monitoring their own networks—like the Milliman data, plans should do those studies themselves. Employers are asking for that,” Henry Harbin, MD, psychiatrist and advisor at The Bowman Family Foundation, told HealthPayerIntelligence.

As insurers confront the escalating mental and behavioral healthcare crisis in the US, working alongside employers in these areas of preventive care, collaborative care, employee assistance programming, and tracking member outcomes could be key.