Employers increased mental health and wellness benefits for employees during the COVID-19 pandemic and are poised to continue expanding these offerings in 2023, a new study shows. However, challenges in accessing care remain for many employees.
Survey results released in August by AHIP, a health insurer trade association formerly known as America’s Health Insurance Plans, highlight how health plans are improving access to mental health (also called behavioral health) services by bringing more high-quality providers into their networks and helping patients find available mental health appointments.
“Even before the COVID-19 pandemic, millions of Americans struggled with mental health and substance use challenges,” said Kate Berry, senior vice president of clinical affairs and strategic partnerships at AHIP, based in Washington, D.C. “The mismatch between provider supply of mental health and substance use disorders and demand for care is a long-standing problem. That’s why health insurance providers are working hard to improve their provider networks and increase access to care.”
When health care providers offer plans with a wide selection of in-network mental health professionals, effective mental health support is more accessible and affordable, Berry said.
AHIP conducted the survey in May and June among its members that offer health plans in the employer-sponsored group market, both self-insured plans that employers design with third-party administrators and fully insured plans purchased by insurance companies. .
“More than half of Americans, nearly 180 million, have employer-provided coverage for their health care needs – which provides an essential pathway to access much-needed mental health support,” AHIP reported.
The survey also included plans sold in the individual market, such as those purchased on an Affordable Care Act exchange.
Based on responses from plan administrators representing 95 million enrollees, the survey found that:
- All respondents provided telehealth coverage for mental health services.
- Number of in-network behavioral health providers offered by health plans increased by an average of 48 percent in three years.
- The vast majority of health plans (89 percent) are actively recruiting mental health care providers, including practitioners who reflect the diversity of the people they serve (83 percent), and 78 percent have increased payments to providers in an effort to recruit more high-quality professionals in their plan networks.
Number of providers qualified to prescribe medication-assisted therapy (MAT) for substance use disorder, including opioid addiction, has more than doubled — increasing 114 percent over three years.
Facilitating access to care
A large majority (83 percent) of plans reported helping enrollees find available mental health appointments. In addition, 78 percent use specialized case managers for follow-up after emergency room and hospital care or initiation of new medications.
“Health insurance providers are taking steps to improve mental health care by proactively identifying the behavioral health needs of their members, partnering with providers and reducing stigma,” Berry said. “While much work has been done, health insurance providers recognize the need to address systemic challenges. This can only be achieved by all health care stakeholders working collaboratively to ensure that Americans have affordable access to mental health support with the high quality they deserve.”
However, many therapists prefer to stay outside the insurance system and collect payments directly from their patients, which limits access to those with lower incomes and limited savings. For example, Manhattan Therapy Collective, a mental health practice in New York City, chose to remain an out-of-network provider because insurers “reimburse therapists on a very late schedule (if at all) and at below-level rates of the market.” and may limit the number of sessions they will pay per year, according to their website.
Other therapists may only offer a certain number of slots for those who cannot pay out of pocket, according to the practitioner website psychology.org. One way to improve the situation is through telehealth, as virtual appointments increase the number of therapy options available to patients and can lower costs for practitioners, who may not need to pay for office space, the website noted.
A gender divide
Women greatly value mental health benefits compared to men (70 percent compared to 49 percent), according to a recent report from benefits technology firm PeopleKeep. The finding is from a May 2022 survey of over 900 employees in small and medium-sized businesses.
“As employers consider their benefits offerings, they must recognize that priorities are sometimes different based on demographics,” said Victoria Glickman Hodgkins, CEO of PeopleKeep.
The fact that men do not place as much importance on the benefits of mental health is a challenge for mental health providers. “From a young age, boys are often told to be strong and independent, keeping their emotions and thoughts to themselves,” Siddharth K. Shah, a psychiatrist in Orlando, Fla., wrote last November . “This belief has far-reaching consequences,” he added.
“In the United States, men are 3.6 times more likely to die by suicide than women,” Shah noted. “Higher Suicide Risk Associated with Men Less Likely to Seek Help for Mental Health Struggles.”
These concerns are shared by Rob Whitley, an associate professor in the Department of Psychiatry at McGill University in Montreal. Writing in Psychology today last year, it encouraged employers and public health providers to increase their outreach efforts targeting men, such as by:
- Providing mental health education programs in workplaces and elsewhere to improve understanding of mental health.
- Ensuring equal treatment of mental and physical health issues in workplaces, discussed in the box below.
Ensuring mental health equity
The Mental Health Equity and Addiction Equity Act (MHPAEA) became law in 2008, but was not “given teeth” until Congress passed the Consolidated Appropriations Act, 2021, requiring employers to assess their compliance with the MHPAEA and ensure that they provide equal coverage limits for mental health/substance use disorder benefits and medical/surgical benefits.
Last April, the Department of Labor issued guidance to help plan sponsors and administrators comply with increased compliance requirements.
Employers, as health plan fiduciaries, “are responsible for making sure vendors have their act together and follow [on mental health parity requirements]or else employers bear the blame,” said Jay Kirschbaum, director of benefits compliance and senior vice president at World Insurance Associates, based in Washington, DC, when he spoke earlier this year at the SHRM 2022 Employment Law and Compliance Conference. “It is your responsibility to ensure that your issuers or vendors are in compliance.”
““Racial and ethnic minorities often suffer from poor mental health outcomes due to cultural stigma and lack of access to mental health care services,” according to the U.S. Department of Health and Human Services Office of Minority Health. In addition, many People from historically marginalized groups face barriers to accessing needed mental health care, an issue compounded by the lack of racial and ethnic diversity among mental health care providers.
“Black and African American providers, who are known to provide more appropriate and effective care to Black and African American claimants, make up a very small portion of the behavioral health provider workforce,” according to Mental Health America (MHA ), a non-profit that addresses the needs of people living with mental illness.
Because nonwhite racial and ethnic groups are underrepresented among American Psychological Association members, “some may worry that mental health care practitioners are not culturally competent enough to address their specific issues,” the MHA said. .
The group pointed to the following statistics from the US Centers for Disease Control and Prevention:
- 58 percent of black youth ages 18-25 and 50.1 percent of black adults ages 26-49 with serious mental illness did not receive treatment (as of 2018).
- Nearly 90 percent of blacks over the age of 12 with a substance use disorder has not received treatment.
According to the MHA, due to barriers to treatment, “Blacks and African Americans are more likely to experience chronic and persistent, rather than episodic, mental health conditions.”
Progress will be made to overcome these challenges “as these issues are shed light on – and the general public holds policy makers and health systems accountable to evolve better systems [that] eliminate disparities in mental health services,” the group said.
According to HR consultants Mercer, “virtual behavioral health care can provide better access to marginalized groups because of its convenience, timeliness, and affordability compared to in-person visits.”
They advise employers to focus on keeping telehealth therapy services “affordable to encourage use in the most vulnerable and high-risk populations.”