Mental Health Parity – It’s Time to Fulfill the Promise! Blog by Deb Krause, Minnesota Health Action Group Vice President

Mental Health Parity – It’s Time to Fulfill the Promise! Blog by Deb Krause, Minnesota Health Action Group Vice President

Recently, I asked a small group of benefits managers and directors at leading Minnesota organizations (a mix of corporate and public sector) a relatively straightforward question: Is your health plan in compliance with the Mental Health Parity and Addiction Equity Act? The answer was unanimous: YES! They were quick to answer for two reasons: (1) they believed it, and (2) even if they didn’t, they were smart enough not to admit that their plan was not in compliance!

Indeed, following the passage of the 2008 law, they, like their peers across the nation, promptly removed the obvious disparities in benefits between physical and mental health. Limits on number of visits and maximum benefits were eliminated, and plans were deemed to provide parity and be in compliance. But, that’s not the full story.

Action Group members who have participated in the 2017 Mental Health Learning Network heard from regional and national subject matter experts and key informants. It became shockingly clear that even now, nine years following the passage of the law, we don’t have true parity. Addressing the benefit design aspect of parity took us only so far. Work remains to be done to fulfill the promise of real parity, including:

  1. Stigma. If an employee is diagnosed with breast cancer, they are comfortable sharing their diagnosis. Managers accommodate the flexible scheduling needed for a regimen of chemotherapy. Coworkers quickly volunteer to join them in community events to raise awareness and funds to fight the disease, and friends express support through cards, flowers and meals for the family. Research shows that a robust support network at work and in the community is important to recovery. However, mental health is different. With few exceptions, stigma still exists. The employee may be reluctant to share a mental health diagnosis, and even if they do, those around them may greet it with silence, not support. Progressive employers are beginning to tackle the issue of stigma, and the most successful ones engage leaders and employees, at all levels in the organization, in emphasizing that “it’s O.K.” to share this illness and that sharing will be met with understanding and support. Successful efforts to bring parity involve communications, training, and cultural change.
  2. Network/access. If an employee experiences a heart attack, they quickly have access to a robust network of cardiologists. However, an employee or dependent with an acute mental health condition may struggle to get in to see a provider. Available mental health specialists are limited, and the wait time for an appointment or a bed can sometimes be weeks or months! Regardless of whether it is appropriate or cost effective, the emergency room often becomes the point of entry for mental health care. In terms of network and access, parity does not exist. Progressive employers are beginning to tackle this by working with their health plans to add standing appointments, broaden the network by contracting with supplemental providers, and offer tele-mental health as an option.
  3. Payment. Lower reimbursement schedules are another example of how parity does not truly exist. Reimbursement schedules for mental health providers lag other specialties, and news of reduced fee schedules has recently received significant attention in Minnesota. Inadequate reimbursement has both workforce implications (fewer physicians drawn to the field) and network implications (mental health specialists may refuse to participate in networks) that ultimately impact the patient. In addition, physicians who provide care coordination services may not be reimbursed by health plans for their services. Much work remains to be done in terms of payment parity.
  4. Outcomes. Over the past dozen years, Minnesota Bridges to Excellence, a purchaser-led pay for performance program has rewarded clinics for providing optimal care for patients with diabetes, vascular disease, and depression. The target performance levels were raised over time, and the average statewide performance has increased to 62 percent and 45 percent for vascular disease and diabetes, respectively. The excellent care delivered by clinicians improved the health of countless Minnesotans affected by these conditions! Yet, despite the attention and effort, the statewide average for depression remission at 6 months remains at only 8 percent. If parity is measured by health outcomes, parity does not exist.

Perhaps the correct answer to the question “is your health plan in compliance with the Mental Health Parity and Addiction Equity Act” is—no, not to the extent it should be.

The easy step of removing arbitrary limits has been taken. The harder steps of addressing stigma, and ensuring parity in network/access, payment and outcomes remains to be done. This is an example of where employers working together can accomplish more than anyone can alone. It will require a strong, firm voice of those who write the checks for health care.

It’s time to fulfill the promise of parity, and The Action Group’s Mental Health Learning Network will continue this important work in 2018.

 

Deb Krause is Vice President for the Minnesota Health Action Group. You may click here to view her bio.