Health plans are recognizing the importance of behavioral healthcare. In addition to meeting parity requirements, plans are proactively engaging with consumers who need behavioral healthcare, coordinating their care across the continuum, and working with them to find community-based support services they may need. A new report
from America’s Health Insurance Plans explores several health plan examples and case studies to ensure access to quality behavioral healthcare.
Untreated behavioral health conditions, including both mental health and substance use disorders, have a significant impact on individuals, families, our economy and society. Health plans and behavioral healthcare organizations recognize the importance of these services in contributing to the overall well-being of their members and are committed to implementing programs that ensure patients have affordable access to high-quality, evidence-based treatments and care.
For exactly these reasons, health plans and behavioral health care organizations support the protections established by the Mental Health Parity and Addiction Equity Act. These programs are designed to raise member awareness of the importance and availability of behavioral healthcare, to encourage discussions with providers, and to focus on proactive identification of behavioral health needs.
Additionally, health plans have demonstrated strong leadership in pioneering innovative programs to coordinate patients' care and meet their individual health needs. Evidence- driven methodology and processes across medical and behavioral benefits are used to determine coverage policies and new payment and care delivery models integrate behavioral health services with patients' treatment plans for chronic conditions.
Ultimate Goal of Health Plans: Engage With Customers
In 2014, an estimated 38 million people had access to behavioral healthcare and benefits. Health plans are successfully collaborating with providers and consumers to help facilitate access to coordinated, affordable, evidence-based behavioral health services.
Ongoing challenges, which may benefit from policy maker attention and potential policy solutions include:
Implementing new workforce programs to address widespread shortages of behavioral clinicians, such as psychiatrists and psychologists who specialize in caring for children and teens
Addressing barriers to more widespread use of telemedicine, which can augment provider capacity and improve consumer convenience
Allowing for substance use diagnosis and treatment information to be securely shared among providers to support care coordination and quality
“However, regular assessment of the adequacy of provider networks helps ensure that members have timely access to behavioral health care while accepted metrics are used to track and improve patients' outcomes,” the report concluded. “Evidence-based clinical criteria are also used to help guide coverage decisions, and there is a heightened focus on integrating behavioral and medical care through greater coordination and communication. Lastly, many health plans and behavioral health care organizations are developing programs specific to certain areas of concern, such as opioid addiction and treatment.”