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Value-Based Insurance Designs in the Treatment of Mental Health Disorders
Alesia Ferguson, PhD; Christopher Yates, BA; and J. Mick Tilford, PhD

Value-Based Insurance Designs in the Treatment of Mental Health Disorders

Alesia Ferguson, PhD; Christopher Yates, BA; and J. Mick Tilford, PhD
This study examined the application of value-based insurance design to the treatment of mental health disorders and addresses any additional challenges.
McAline and Mechanic, in their national telephone study across 60 US communities, found that those with severe mental health disorders were likely to be African American males without health insurance and with criminal involvment.53 Such inequity issues driven by sociodemographic characteristics have chronically plagued attempts to successfully treat mental health disorders, making programs difficult to implement or evaluate across various populations. Removing barriers associated with these variables need to be integrated into mental health services to better reach these particular populations and should be considered in potential V-BID application. As the ACA evolves and more Americans get health coverage, changes in access to mental health services will likely ensue. Still, issues of stigma and perceived need among various populations may nonetheless continue to hinder access; they need to be addressed in a comprehensive V-BID program.

CONCLUSIONS
V-BID incorporates incentives—such as lowered co-pays and deductibles—for additional consumption of upfront health services ranging from pharmacy usage, wellness and counseling programs, and consultation with physicians to online support access. V-BID applied to mental health disorders could prove cost-effective, with improved health and reduced consumption of health services resulting in the long run. That, at least, is the goal. Implementation and management costs of such V-BIDs also must be considered in a full cost analysis. The cost savings of an effective mental health V-BID will not necessarily be realized within healthcare systems; a complete analysis must consider all welfare and social costs, which could be substantial.

Implementation of V-BID in the treatment of mental health disorders presents challenges, the first major one being insurance companies’ and large employers’ acceptance. Their buy-in is necessary to ensure the V-BID programs are implemented and sustained over the long run. Investment in these programs for mental health disorders will grow if pilot programs can demonstrate cost savings, as well as increased employee adherence and productivity. Other challenges include privacy issues for implementation in the workplace and adherence issues for those with diminished capabilities to comprehend program benefits and/or lack of family support. Research projects—such as comparative effectiveness research studies—focused on applying V-BID to mental health disorders and on demonstrating cost savings can generate additional information on effective strategies and treatments to reduce DALYs, and on-demand response for various mental health services across various populations.

Author Affiliations: Department of Environmental and Occupational Health (AF) and Department of Health Policy and Management (JMT), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock; Green Bay Packaging, Arkansas Kraft Division (CY), Morrilton, AR.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. The views expressed are those of the authors and do not necessarily reflect the views of the University of Arkansas for Medical Science or Green Bay Packaging. During the preparation of this manuscript, Mr Yates was an undergrad student at the University of Arkansas Little Rock, and is also a technical writer for Green Bay Packaging.

Authorship Information: Concept and design (AF, CY, MT); acquisition of data (AF, CY, MT); analysis and interpretation of data (AF, CY, MT); drafting of the manuscript (AF); critical revision of the manuscript for important intellectual content (CY, MT).

Address correspondence to: Alesia Ferguson, PhD, Department of Occupational and Environmental Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 820, Little Rock, AR 72207. E-mail: aferguson@uams.edu.
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