Mental Health Parity: Eliminating Barriers to Effective Mental Health Care
Volume 3, June 2009
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For decades, great disparities have existed between health care benefits for mental health disorders and physical health disorders. Those seeking treatment for mental health conditions have faced higher co-payments and deductibles, as well as more restrictive limits on treatment — as compared with the corresponding benefits allowed for most physical health conditions.
As of January 1, 2010, this longstanding model in America’s health care system will undergo dramatic changes as the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) goes into effect. This landmark legislation is slated to improve coverage for more than 113 million Americans — including 82 million individuals enrolled in self-funded plans — by requiring parity between mental health benefits and physical health benefits.
According to the National Institute of Mental Health, one in four Americans suffers from some form of diagnosable mental disorder each year. “The Wellstone Domenici parity laws will remove some of the financial hurdles that people suffering from behavioral disorders have had in front of them,” said Stephen Melek, F.S.A., MAAA, Principal and Consulting Actuary at Milliman, Inc. “It’s going to be easier to get treatment.”
Under the MHPAEA, a group health plan of 50 or more employees that provides both medical and surgical benefits and mental health or substance use benefits must make sure that all financial requirements and treatment limitations associated with mental health and substance use benefits are no more restrictive than those placed on medical and surgical benefits. This includes deductibles, co-payments, co-insurance, out-of-pocket expenses, lifetime and annual dollar limits, and all treatment limitations.
While this legislation will not require health plans to provide coverage for mental illness, it does direct that, if mental health treatment is covered by a plan, benefits must be as broad as those provided for physical health conditions.
“Passage of this Act will provide opportunities to better integrate behavioral health with medical health; to stop treating the mind and body separately, and instead, treat the whole person,” said Melek. “This is actually an opportunity to invest in mental health care in a fashion that our country has not addressed on a national level. It will change the way behavioral health care is provided.”
While attitudes about mental health have undergone considerable shifts over the years, there are still challenges ahead in redefining the concept of mental illness. “The stigma often associated with mental disorders has lessened, but it still exists,” said Melek. “More people are beginning to realize the value and benefits that go with effective mental health care.”
The MHPAEA follows the 1996 Mental Health Parity Act that lifted restrictions on mental health coverage by incorporating guidelines on co-payments, deductibles, and length of treatment.
“Since the 1996 legislation, there have been a plethora of state laws — some limited and some more comprehensive — regarding parity between mental health and physical health. I call it ‘mental health lite.’ It didn’t accomplish much of anything,” said Melek. “The earlier legislation just moved health plans to a different design approach to behavioral health benefits, but didn’t increase benefits at all.”
Most experts agree that effective mental health care is associated with improved clinical and financial outcomes. It has become increasingly important to address behavioral health problems that are co-morbid with chronic physical health conditions, such as diabetes. “Healthcare costs are substantially higher when these types of co-morbidities exist. Comorbid psychological disorders, such as depression, can greatly exacerbate chronic physical conditions. Getting effective treatment for both the physical and psychological conditions can result in significant healthcare cost reductions down the road” said Melek.
Moreover, research shows that the indirect costs of untreated mental disorders such as depression is high and often results in absenteeism, disability, and presenteeism in the workplace. When treated effectively, however, employees suffering from depression show increased productivity and reduced number of lost work days.
Health plans/employers understand the importance of implementing safe, cost effective, scalable, and confidential options for treatment for depression, insomnia, and substance abuse. One such scalable option is adding on-line Digital Health Coaching. HealthMedia’s digital behavioral health interventions are showing measurable results. Recent published outcomes from the HealthMedia’s Overcoming Depression intervention are showing impressive results. This HealthMedia® study illustrated that:
- 41% decrease in average CES-D scores from 5.02 to 2.96
- 16% increase in the confidence to manage depression
- 24% improvement in productivity impairment (31% to 23%).
- $3,832 productivity savings per year per participant
The MHPA will help drive behavioral health solutions to be part of disease management and wellness — according to Melek, “they can no longer be “carved out and administered in a vacuum. Increased screening promotes early identification and remediation of health plan members and employees with behavioral health problems. Short-term increases in treatment expenses can be offset by improved medical outcomes and increased productivity.” Innovative and scalable interventions such as including web-based Digital Health Coaching programs can offer alternatives to medication and high touch services and can reach those who may never come forward.