Employers must rewrite the rules for behavioral health treatment

Sixty-nine years ago, U.S. congress designated May as Mental Health Awareness Month at a time when the stigma for this condition was pervasive. Over the past seven decades, mental health has become recognized as part of a more holistic category — behavioral health. It acknowledges that emotions, behaviors and biology all impact a person’s mental wellbeing, and they manifest in various ways — from mood and sleep disorders, to substance abuse, or behavioral challenges in adolescence.

Unfortunately, the systemic barriers to behavioral health treatment remain in place. Although behavioral health conditions are an important national issue that affect roughly one out of five adults, Americans aren’t getting the care they need, in spite of having health insurance. In fact, 56.5% of adults with mental illness received no treatment in the past year, according to Mental Health America.

Another major problem is the difficulty in using insurance to access care. Behavioral health treatments are rarely classified as primary care, and are regarded instead as specialty treatment. This forces people to find an in-network provider, go out of network and pay higher out-of-pocket costs, or avoid treatment altogether. For context, 2017 claims data from Collective Health shows that behavioral health spend was 14 times as likely to be out-of-network as other types of care like primary or preventative.

Fortunately, in our employer-driven healthcare economy, American companies have the ability to challenge the status quo. Self-insured employers, in particular, are in a unique position to alleviate the friction to getting behavioral healthcare. Some of the most forward-thinking companies have recognized this, and are already turning to health plan design to drive new approaches.

Health plan design is the foundation of a health benefits strategy, and it’s an opportunity for self-insured employers to get creative to ensure employees are getting access to proper behavioral health care. There are a lot of new and interesting plan design ideas out there, and a few successful tactics employers are deploying include:

● Treating out-of-network behavioral health treatments as in-network, meaning employees pay the same amount treatment regardless of who they visit.

● Covering out-of-network behavioral health services on their plan even if it doesn’t cover out-of-network services for other care areas.

● Setting a lower coinsurance for out-of-network behavioral health than for the rest of the out-of-network benefits.

One other critical tactic is unlocking digital health and telemedicine solutions.

According to the Large Employers’ 2018 Health Care Strategy and Plan Design Survey, 96% of employers plan to make telehealth services available in states where it is allowed by next year — and 56% plan to offer telehealth specifically for behavioral health services. Telemedicine can reduce costs and make accessing behavioral health care easier, but historically, it has only been available via a point solution. However, with many providers now offering telemedicine services, employers are allowing telemedicine to be covered by individual providers.

There’s also an expanding ecosystem of innovative behavioral health solutions, including offerings from companies like Lyra, Joyable, and Rethink, that target specific behavioral health needs.

These programs can be incredibly effective complements to traditional care, and can be implemented into company health plans. Proprietary data analyzed by Collective Health found that implementation of behavioral health solutions continues to outpace implementations of solutions from all other clinical care areas, such as maternity care or preventative care.

Anyone who has struggled with a behavioral health issue knows how isolating it can feel — a feeling that compounds when the person can’t figure out what’s available to them, or how much they’ll have to pay. Increasingly, employers are eager to empower their employees to be better consumers of healthcare by embracing technology tools that help them navigate their health plans, provide better advocacy and increase engagement.

If the moral imperative isn’t a strong enough reason to invest in behavioral health, consider the financial implications: Mental illness is the single greatest cause of worker disability in the U.S., and mental health conditions cost the economy an estimated $193 billion dollars in lost earnings each year.

In a country where 217 million days of work are lost annually due to productivity decline related to behavioral health, the financial case makes itself for employers to continue exploring new approaches for helping their employees seek the care they deserve.