Employers poised to expand mental health coverage in 2023

Employers have 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. However, challenges in accessing care remain for many employees.

The study 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 (also called behavioral health) services by including more high-quality providers in their networks and helps 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 Washington, D.C.-based AHIP. of mental health and substance use disorder and care seeking 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 conducted the survey in May and June among its members who offer health plans in the employer-sponsored group market, both self-insured plans that employers design with third-party administrators and fully insured plans purchased from insurance carriers.

“More than half of Americans, nearly 180 million, have employer-provided coverage for their health needs – offering a major pathway to accessing much-needed mental health support,” reports AHIP.

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

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

  • All respondents provided some telehealth coverage for mental health services.
  • The number of behavioral health providers in the network offered by health plans have grown an average of 48 percent over three years.
  • Most health plans (89 percent) are actively recruiting mental health care providers, including practitioners who reflect the diversity of the people they serve (83 percent), and 78 percent have increased payments to providers in an effort to recruit more high-quality professionals to their plan networks.
  • The number of providers authorized to prescribe medication-assisted therapy (MAT) for a substance use disorder, including opiate dependence, has more than doubled—rising 114 percent in three years.

Facilitating access to care

A large majority (83 percent) of plans reported helping enrollees find available mental health appointments. In addition, 78 percent use dedicated case managers for follow-up after emergency department and hospital care or starting 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,” Berry said. “While much work has been done, health insurance providers recognize the need to address systemic challenges. This can only be achieved by all healthcare stakeholders working together to ensure Americans have affordable access to the high-quality mental health support they deserve. “

However, many therapists prefer to remain outside the insurance system and collect payments directly from their patients, which limits access to those with lower incomes and limited savings. For example, 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 slow schedule (if at all) and at below-market rates,” and may limit the number of sessions they will 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 practitioner website psychology.org. One way to improve the situation is through telehealth, as virtual appointments increase the number of therapeutic options available to patients and can reduce costs for practitioners who may not have to pay for office space, the website notes.

Separation between the sexes

Women greatly value mental health benefits compared to men (70 percent compared to 49 percent), according to a recent report by benefits technology firm PeopleKeep. The finding is from a May 2022 survey of over 900 employees in small and medium-sized businesses.

“As employers consider their benefits offerings, they need to recognize that priorities sometimes differ by demographic,” said Victoria Glickman Hodgkins, CEO of PeopleKeep.

The fact that men do not place as much value on mental health benefits is a challenge for mental health providers. “From a young age, boys are often told to be strong and independent, keeping their emotions and thoughts to themselves,” wrote Siddharth K. Shah, a psychiatrist in Orlando, Florida, last November. “This conviction 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 suicide risk is associated with men being less likely to seek help for mental health problems.”

These concerns are shared by Rob Wheatley, an associate professor in the department of psychiatry at McGill University in Montreal. Writing in Psychology Today last year, he encouraged employers and public health providers to increase their outreach efforts targeting men, such as by:

  • Offers mental health programs in workplaces and elsewhere to improve understanding of mental health.
  • Ensuring equal treatment of mental and physical problems in the jobs discussed in the box below.

Ensure mental health parity

The Mental Health Equity and Addiction Justice Act (MHPAEA) became law in 2008, but it wasn’t “given teeth” until Congress passed the Consolidated Appropriations Act of 2021, requiring employers to assess their compliance with MHPAEA and ensure that they provide equal coverage limits for mental health/substance use benefits and medical/surgical benefits.

Last April, the Department of Labor issued guidance to help plan sponsors and administrators comply with increased compliance requirements.

Employers, as health plan fiduciaries, “are responsible for ensuring that vendors act together and follow [on mental health parity requirements]or else employers are at fault,” said Jay Kirschbaum, director of benefits compliance and senior vice president at World Insurance Associates, based in Washington, D.C., when he spoke earlier this year at the 2022 SHRM Employment Law & Compliance Conference. “It is your responsibility to ensure that your publishers or suppliers comply with the rules.”

Racial barriers

“Racial and ethnic minorities often suffer poor mental health outcomes due to cultural stigma and lack of access to mental health services,” according to the Office of Minority Health at the U.S. Department of Health and Human Services. Additionally, many people from historically marginalized groups face barriers to accessing needed mental health care, a problem compounded by the lack of racial and ethnic diversity among mental health care providers.

“Blacks and African Americans known to provide more appropriate and effective care to Black and African Americans seeking help make up a very small portion of the workforce of behavioral health providers,” according to Mental Health America (MHA), an organization non-profit that meets the needs of people living with mental illness.

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

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

  • 58 percent of black youth ages 18-25 and 50.1 percent of black adults ages 26-49 with a serious mental illness did not receive treatment (as of 2018).
  • Nearly 90 percent of black people over the age of 12 with a substance use disorder that has not received treatment.

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

Progress will be made to overcome these challenges “when these issues are brought to light – and the general public holds politicians and health systems accountable to develop better systems [that] eliminating inequalities in mental health services,” the group said.

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

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

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