The rising price for mental illness, drug abuse care
Eleven years after Congress passed a law mandating that insurers provide equal access for mental and physical health care, Americans are actually finding it harder to obtain affordable treatment for mental illness and substance abuse. The barriers to parity continue despite a bipartisan consensus that more must be done to confront the nation’s devastating opioid epidemic, rising suicide rates and surging rates of teen depression and anxiety.
A report published by Milliman, a risk management and health-care consulting company, found that patients were dramatically more likely to resort to out-of-network providers for mental health and substance abuse treatment than for other conditions. The disparities have grown since Milliman published a similarly grim study two years ago.
The latest study examined the claims data of 37 million individuals with commercial preferred provider organization’s health insurance plans in all 50 states from 2013 to 2017.
Among the findings:
— People seeking inpatient care for behavioral health issues were 5.2 times more likely to be relegated to an out-of-network provider than for medical or surgical care in 2017, up from 2.8 times in 2013.
— For substance abuse treatment, the numbers were even worse: Treatment at an inpatient facility was 10 times more likely to be provided out-of-network — up from 4.7 times in 2013.
— In 2017, a child was 10 times more likely to go out-of-network for a behavioral health office visit than for a primary care office visit.
— Spending for all types of substance abuse treatment was just 0.9% of total health-care spending in 2017. Mental health treatment accounted for 2.4% of total spending.
In 2017, 70,237 Americans died of drug overdoses, and 47,173 from suicide, according to the Centers for Disease Control and Prevention. In 2018, nearly 20% of adults — more than 47 million people — experienced a mental illness, according to the National Alliance on Mental Illness.
“I thought maybe we would have seen some progress here. It’s very depressing to see that it’s actually gotten worse,” said Henry Harbin, former chief executive of Magellan Health, a managed behavioral health-care company, and adviser to the Bowman Family Foundation, which commissioned the report. “Employers and insurance plans need to quadruple their efforts.”
Insurance plan networks are simply inadequate, Harbin said, which is no surprise, given that insurance companies consistently reimburse behavioral health providers at lower rates. The study found, for example, that primary-care office visit rates were on average 23.8% higher than rates for behavioral health office visits.
If a plan had a shortage of oncologists or cardiologists, he said, an insurance company would pay more to get additional providers into the network. “It can be done pretty quickly,” he said. “Just raise rates in the areas where you’re short, like they do on the medical side.”
Tom Insel, a psychiatrist who serves as chief adviser to California Gov. Gavin Newsom on mental health issues, called the results of the study “stunning.” In California, the report found that inpatient behavioral health care was 7.8 times more likely to be out-of-network.
“For people with serious mental illness, you actually have better access to care if you have Medi-Cal than commercial insurance. That is virtually unthinkable for medical conditions,” said Insel, who led the National Institute of Mental Health from 2002 to 2015. “We would never permit this for heart disease or cancer.”
Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, the industry’s main trade group, said insurers are working diligently to ensure they are complying with the federal parity law. But the national shortage of mental health providers, along with the many clinicians who do not want to participate in insurance networks, contribute to more patients needing to go out-of-network for care, she said.