Declaring a National Crisis, Providing Affordable Mental and Behavioral Support Remains a Priority for Employer Sponsored Health Plans

As our nation continues to experience a surge in post-pandemic demand for behavioral health counseling and therapy over residual stress, anxiety and depression, Americans are finding it difficult to access and afford mental and behavioral health services. In fact, President Biden declared a National Behavioral Health Crisis during his 2022 State of the Union address, unveiling an ambitious plan that received bipartisan support to address the nation’s mental health needs.

According to a policy brief issues the White House, at the center of our national mental health crisis is a severe shortage of providers. More than one-third of Americans live in designated Mental Health Professional Shortage Areas, communities that have fewer mental health providers than the minimum their level of population would need. The administration calls for a dramatic expansion of the supply and diversity of our mental health and substance use disorder workforce – from psychiatrists to psychologists, peers to paraprofessionals – and increase both opportunity and incentive for them to practice in areas of highest need.

How This National Crisis Impacts Employers and Employees

The struggles of mental health impact the workplace is a key concern for employers to address this issue while also financially sustaining employee health coverage as a benefit. While there are many health and wellness programs an employer can offer to employees, most do not evaluate the effectiveness to ensure they are supporting the mental well-being of workers. The hope of plan sponsors is their ability to offer participants behavioral health services that qualify in the same manner as medical coverage within their provider networks.

In many cases, employees are still paying out of network and out of pocket to address their behavioral health needs independent of their health plans, adding expenses to their financial fragility. McKinsey published insight on the affordability of mental healthcare and the long-term impact on financial health. Findings claim that those who report mental illness disproportionately faced economic disadvantages and greater financial stress. Affordability barriers are compounding these challenges by limiting mental health access for many in need.

According to a survey conducted by the Kaiser Family Foundation, nearly 4 out of 10 employers changed their benefits to better expand mental health services to employees. Providing mental health support is shown to result in fewer missed workdays and increased return to work rates. Among employees surveyed, those with anxiety or depression report missing, on average, roughly six times more workdays per year than individuals without a mental health condition.

The National Alliance of Healthcare Purchaser Coalitions polled 221 employers that provide coverage to more than 10 million employees and their dependents and found that just 31% are satisfied with network access for behavioral health care services. In addition, only 34% of employers said that their behavioral health care directors accurately reflected the providers available to their plan members. This study found a strong employer consensus on what is critical and significant variation in health plan and vendor performance. Many of the services provided, particularly in managing network access, continue to fall short of employer expectations. The study concluded that we need to work collaboratively with all stakeholders, especially health plan and vendor partners, if we are going to be able to provide timely access to affordable, high-quality behavioral health providers.

How Employer-Sponsored Health Plans Can Support Mental Health Needs of Employees

1) Mental Health Parity and Long-Term Disability Benefits

The Mental Health Parity Act (MHPA) of 1996 provided that large, employer-sponsored (group) health plans and their insurers cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on physical health benefits.

Limited Network Coverage is a prime issue for employer-sponsored plans. These networks are relatively less robust and adequate for mental health claimants and substance use disorder claimants than for medical claimants. In situations where a Long-Term Disability (LTD) insurance policy limits disability income benefits when the result of mental illness, the physician may submit it as qualifying due to other comorbidities.

2) Reference-Based Pricing Solution

When out-of-network usage rates are different for mental health claimants than medical claimants, it’s not that workers aren’t receiving services or mental health providers aren’t available, it’s that participants have to pay for service at out-of-network rates. Most mental health and substance abuse providers are currently out of network, making Reference-Based Pricing (RBP) an applicable strategy. This can be applied by careful plan design and network construction. If network coverage (access to mental health providers who will provide treatment and contract over fees) is modest, that may be a great option for “pure” RBP.

RBP is one of the fastest growing solutions in health benefits cost management – potentially lowering the cost of coverage and employee point of purchase cost sharing. When done right,

a “pure” RBP structure, coupled with tech-driven data support, may avoid unreasonable or excessive provider charges. This structure doesn’t depend on a network’s ability to negotiate a price for a specific provider in a specific location for specific services. There are no in-or-out-of-network claims, nor is there any determination of a median in-network rate – because there are no contracted rates. A pure RBP avoids the cost of direct contracting and network access fees. Further, because in-network charges also tend to vary substantially from provider to provider, pure RBP ensures the reference price applies in every situation.

As a result, deploying a “pure” RBP plan, with appropriate participant protections, has lowered both the employee point of purchase cost sharing (deductibles, copayment, coinsurance) and the cost of benefits – which, in turn, over time, lowers the cost of coverage by lowering both employee and employer contributions.

3) Alternative Approach to Mental Healthcare

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals and follow-up services to employees who have personal and/or work-related problems. The EAP is an employee benefit that is separate from the health insurance plan and is already paid for by the employer. There is no charge to the employee for the assessment process that the EAP provides. (Alprazolam)

The Employee Wellness Initiative is another program intended to improve and promote health and fitness that’s usually offered through the workplace, although insurance plans can offer them directly to their enrollees.