The Future of Mental Healthcare Coverage

The COVID-19 pandemic has spurred one key question for the beginning of 2021, and that question is, "What does the future of mental healthcare coverage look like in 2021?". That is a complicated question that we hope to answer in this blog and hope to bring relevant resources to the front of the conversation on this topic.

The first key assumption to make in the conversation around the future of mental healthcare coverage moving into 2021 is that insurance companies and large healthcare providers are starting to think programmatically about the changes they would make in relation to the cultural and philosophical changes that are coming as a result of the virus.

Victor Armstrong, director of the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse services said in a recent interview:

I think that some of the things that we can do programmatically would involve how we can better integrate care. But I think where there needs to be changes, philosophically and culturally, is that we may need to rethink what integration means.

We’ve done some work on, within our systems, on integrating behavioral health into primary care, and primary care into behavioral health. I think where we still have challenges are how do we integrate behavioral health into a community setting. And I think that’s where public institutions can play a role because we can pilot, we can build programs, that would allow us the opportunity to really build services that take into account not just the behavioral health needs and the physical needs, but also how do we weave in the social determinants of health.

How do we look at integrating behavioral health into the faith-based community, into the YMCAs, [and] into communities where people live and congregate? So, I think that’s one of the things that we can focus on. As we’re answering this question, I think we also have to look at the lessons that we’ve learned from the COVID-19 pandemic.

The point that Victor is making is very similar to the changes that Blue Cross Blue Shield of Massachusettes made about a decade ago. About a decade ago, BCBS of Massachusettes made the decision to take mental healthcare and thrust the treatment of mental health disorders into the mainstream of privatized insurance.

The first thing they did was to stop carving out mental health insurance to other companies. This process is one that the Practice Solutions team is very familiar with and can create a wide range of credentialing and billing headaches. If you are struggling with a carve-out company, please give us a call so we can help iron out the issues. BCBS of MA hired a number of clinicians to work alongside physicians to make sure that care for patients was as integrated as possible.

Then BCBS of MA made an interesting discovery: When clinicians started to accept some financial and clinical risk for the care they were offering in the form of a value-based payment model, the clinician would integrate social workers and psychologists at a higher rate. In short, the clinician wanted to make sure that the care provided was of the highest quality that they could come by.

The next radical thing that BCBS of MA did was to open up the network to basically every clinician in the state, which created a very broad network of clinicians for the members in the state. Andrew Dreyfus, the CEO of BCBS of MA states:

And then, you know, we started hearing complaints about administrative barriers. And so, we eliminated most of those, partly so, because many of our mental health clinicians are solo practitioners—they’re in a small practice without much administrative support.

We wanted to try to kind of radically simplify their experience of working with a health plan. So, the only paperwork they really had to provide is to send us a bill. These changes resulted in adding about 2,000 clinicians to our network over the past few years. And we’ve seen a really significant uptick in mental health services by our members who saw over 2018, a 43 percent increase in the care our members were receiving.

And that did increase spending. But we also saw a 40 percent reduction in spending outside of the network. And that seemed to be another positive development. At the same time, we were working on the addiction side, too. We dropped copays for things like methadone and Narcan and we eliminated prior authorization for Suboxone treatment.

Think about that, a 43 percent increase in the care that the patients were receiving just by simplifying the administrative work that private practice clinicians need to do!

This is one example of many that demonstrates that private healthcare companies are doing everything they can to ensure that access to mental healthcare is accessible for all people, and to ensure that engagement with those services is consistent.

The second assumption to make when looking at the future of mental healthcare in the coming years is that healthcare companies, private companies, and healthcare insurance companies must work to rebuild frontline worker mental healthcare. According to a study done by Mckinsey:

3% of frontline workers are bunt out

8% feel frustrated at work most of the time

23% feel frustrated by work and burnout symptoms won't go away

28% feel they are under occasional stress

18% don't have burnout

If you are in the 18% that don't have burnout, we cheer for you and are very happy that you have found a delicate balance! Please share your secrets with the rest of the healthcare world.

However, most frontline healthcare workers are not feeling the same way. Existing evidence suggests that mental health and well-being programs can have a significant positive impact. Impaired well-being, such as burnout, is a key driver of physician turnover. In addition to the human cost, this also has a considerable financial cost to the health system; replacing a physician costs two to three times a physician’s annual salary.

Insurance companies, private organizations, and public organizations are looking to expand their education on mental health best practices and deploy regular risk assessments for students, trainees, and staff.

With these two key assumptions in place, along with the data that has arisen from the pandemic, there are a few actions that companies need to take in order to shape the future of mental healthcare in a post COVID world.

Here are some of the actionable items that are needed to build a stable mental health infrastructure in a post-COVID world:

First, there needs to be increased access to counseling services in healthcare facilities and companies across the country, which should include areas for providers, doctors, and employees to engage in stress-relieving activities. Counseling services ought to become an integrated facet of work-life and healthcare facilities.

Second, there needs to be logistical support for providers and patients that are receiving healthcare services. This could include childcare, billing, credentialing, general administrative support, housing, financial support, or patient advocacy programs. These kinds of support structures help clinicians and patients wade through the sea of concrete that makes up the healthcare industry.

Third, agile and flexible working models that would allow employees and healthcare workers to focus on the schedule that would be right for them. The CDC actually defines some overnight shift work to be a "probably carcinogen" because of the connection between sleep and certain cancer clusters.

Fourth, implementing a hazard pay system for clinicians or increased reimbursement models for difficult working conditions. Some states also have addressed hazard pay. In December, Vermont legislators approved additional funding for the Vermont Frontline Employees Hazard Pay Grant program, which means up to 20,000 Vermonters who work in healthcare, grocery stores, and other sectors in the spring will receive checks of $1,200 or $2,000.

As we move into a new year, designing a mental healthcare system to address the wide-sweeping changes and traumas of 2020 will take time, but with the right resources and advocacy, changes can be made. At Practice Solutions, we are striving to be a part of the transformation of the logistical support for mental health clinicians across the country and are happy to contribute in wide cross-sections of applications.

If you are interested in learning more, feel free to reach out to us or subscribe to our blog for regular content updates!