- More comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent by employers, says a report from the National Alliance of Healthcare Purchaser Coalitions (NAHPC).
One in five adults experience mental illness in a given year but only 41 percent of people with a mental illness receive treatment for their condition, said the NAHPC. Gaps in mental healthcare insurance coverage are partly to blame for low rates of treatment.
There are direct financial consequences for these shortfalls, the report added. Nationally, employers are losing out on $225.5 billion a year due to reductions in productivity related to employee anxiety, stress, depression, and substance use disorder (SUD).
“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,” said Michael Thompson, president and CEO, National Alliance.
“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. Parity is the law – and improved performance is good business.”
Employees are likely to experience a lack of consistent and timely access to clinicians and medications for mental health needs, NAHPC found.
Ninety-five percent of primary care physicians join commercial health plan networks, while only half of mental health and SUD specialists are contracted in a commercial network. NAHPC determined mental health specialists may have an financial incentive to remain out-of-network.
“We have heard for years anecdotally that patients cannot get timely in-network care (access),” NAHPC said. “We also note that the MH/SUD specialists may be advised not to join networks due to reimbursement issues: when these same providers are accessed out-of-network, they may submit claims for higher amounts or get paid in cash at time of service.”
Employers also encounter stigma surrounding mental healthcare.
Many workplaces may openly talk about addressing chronic care and overall health, but some still have a negative interpretation of mental healthcare. NAHPC urged employers to address these challenges.
“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 employees and families have access to high-quality mental health services and treatment,” said Henry Harbin, MD, a psychiatrist and former CEO of Magellan Health Care.
“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.”
Employers should start to address mental health disparities by reviewing the impact of mental health on employers’ costs and employees’ well-being, the report said.
Tools including cost calculators can help employers evaluate the cost of mental health benefits. Claims data can inform employers about employees’ most important mental healthcare needs.
NAHPC also suggested employers conduct an independent plan design review with mental health experts to address any gaps in mental healthcare access. Health plan sponsors can also set specific mental health coverage guidelines for health plans and restructure health plan benefits to emphasize mental health.
Health plans could address access challenges by providing digital and telehealth access to mental health services. Employers may also want to encourage health plans to use new payment models that provide competitive payment rates for in-network mental health specialists.
Employee engagement strategies can reduce stigma and connect employees to mental health services, the report said. An employer can train managers and supervisors to identify mental health issues and initiate dialogues about treatment options, the team advised.
Employers can also connect employees to mental health services through apps and other digital outlets that make it easy to find mental healthcare.
The team’s recommendations have already helped Fortune 500 companies address gaps in mental healthcare and reduce problematic mental health issues for employees.
In one case study, American Express implemented an employee assistance program (EAP) to destigmatize mental healthcare. The EAP leverages communication and engagement tools to identify employees’ mental health needs. American Express also employed an internal mental health specialist.
The EAP helped American Express decrease the incidence of medical and behavioral health claims. The American Psychological Association recognized the innitiative for excellence in providing mental healthcare.
“The results of this report highlight significant industry concerns and opportunities to review current practices and develop action plans to improve access to high-quality care and support within both the medical (primary care) and behavioral delivery systems,” NAHPC concluded.
“With gaps that have been described in the identification, treatment, and management of behavioral health conditions, we have now set a new bar for purchaser expectations and a collective roadmap to meet those expectations.”