Mental Health Benchmarking

As of 2014, the Affordable Care Act (ACA) requires most individual and small group health insurance plans, including plans sold on the Marketplace and Medicaid Alternative Benefit Plans, to cover mental health and substance abuse disorder services. This includes behavioral health treatment, counseling, and psychotherapy.

Additionally, health plans must comply with the requirements set forth in the Mental Health Parity and Addiction Equity Act (MHPAEA), meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.

Trends in Mental Health Services

Since more plans are now required to cover mental health services, more people are using them. As of January 2015, an estimated 3.7 million Americans with significant mental illnesses gained access to care through the insurance exchanges and extended Medicaid coverage.

More employees are seeking care for depression, anxiety, and stress, according to a study from Workplace Options. For example, the number of cases of employee depression increased by 58 percent between 2012 and 2014. Similarly, anxiety cases increased by 74 percent, and the number of cases of employee stress grew by 28 percent.

Furthermore, according to the University of Minnesota’s School of Public Health, following the first year of the ACA, inpatient mental health care for younger adults increased, while emergency room (ER) psychiatric care decreased—meaning that younger patients are getting care when they need it, instead of waiting for a crisis and visiting the ER. This, in turn, improves the quality and delivery of care and reduces the expense of treatment.

Similarly, according to data collected by Mercer, surveyed employers saw a 3.4 percent increase in mental health and substance abuse claims. In addition, the number of claims per claimant rose by 7.5 percent. This study also found that the total number of out-of-network claims for mental health services has grown, perhaps due to adult dependents in college (who are still on their parents’ plans but go to school in a different city or state) who don’t have access to in-network care. Also, in-network care might be limited in certain areas.

Pre-existing Conditions

Another aspect of the ACA that is encouraging people to use mental health benefits is the elimination of the pre-existing condition exclusion for non-grandfathered health plans. What is frequently seen as a benefit for cancer survivors or people with chronic conditions is also a benefit for individuals with mental health issues. Before the ACA, the idea of losing or being denied insurance was a barrier for people recovering from mental health disorders. Now, they don’t have to worry about losing coverage. In addition, the ACA also eliminates lifetime or yearly dollar limits on mental health care—recognizing that services and recovery can take time for patients and families and that the costs associated with recovery can be extensive.

The Effect of Mental Health Coverage on Employers

Each year, 18 percent of the U.S. population experiences some type of mental illness, according to data released by the U.S. Substance Abuse and Mental Health Services Administration. Mental illness causes individuals to miss more workdays than any other chronic condition, resulting in an estimated $100 billion per year in indirect costs to U.S. employers.

Employers should know that a mentally healthy workforce is linked to lower medical costs, as well as less absenteeism. In contrast, a mentally unhealthy workforce is linked to loss of productivity. Therefore, employers should be aware of the need to ensure that they have the resources to turn a mentally unhealthy workforce into a productive, healthy one.

Creating a Stigma-free Workforce

In order to encourage a mentally healthy workforce, employers need to ensure that their workplace is stigma-free. It is counterintuitive to offer mental health benefits if employees feel as if they will be judged for using them. The National Mental Health Association and the National Council for Behavioral Health recommend the following actions:

  • Educate employees about the signs and symptoms of mental health disorders.
  • Encourage employees to talk about stress, workload, family commitments and other issues.
  • Communicate that mental illness is real, common and treatable.
  • Discourage stigmatizing language, including hurtful labels, such as “crazy.”
  • Invest in mental health benefits.
  • Help employees transition back to work after they take leave.
  • Offer an employee assistance program (EAP).

Evaluating Current Mental Health Benefits

Employers should also evaluate their current mental health benefits to make sure they are sufficient for employees to receive needed care. The following questions should be asked of their insurance carriers:

  • Do they offer readily accessible mental health information through employee educational programs, their website or self-screening tools?
  • Do they have a toll-free number for your employees to call for help with personal, family or work issues?
  • Is there a sufficient number of available, in-network providers who are trained in screening for and treating depression, anxiety, and substance abuse disorders?
  • Can they integrate their services with your EAP, disease management, and disability benefits? Integration results in better coordination of care for employees and can save employers time, effort and money.
  • Are pharmaceutical benefits sufficient enough for employees to be able to afford needed medication?

Although the ACA has made an impact on mental health care, further implementation and expansion of coverage to at-risk populations are still needed in order to realize the full impact. For more information on mental health benefits, contact Sapoznik Insurance today.