The COVID-19 pandemic has created significant mental health challenges for many around the world, both directly due to the consequences of the disease, and indirectly due to the difficult circumstances that arise from mitigation strategies.
During the pandemic, the gap in care for mental illnesses and substance use disorders has been magnified by the reduction in face-to-face office visits for treatment resulting from restrictions on elective care visits, physical distancing guidelines, and the fear of spreading or contracting the disease. This challenge is being addressed by some insurers and providers through rapidly increasing use of telehealth tools to provide treatment for mental illnesses and substance use disorders.
In this article, Milliman’s Steve Melek, Stoddard Davenport, and Travis Gray explain why telehealth visits may become part of the “new normal” for replacing, or at least supplementing, office visit-based treatment for behavioral health conditions.
The state of Colorado has implemented integrated behavioral
healthcare in primary care medical settings under a Centers for Medicare and
Medicaid Services State Innovation Model Award. This program includes about 325
primary care practices across the state and four community mental health
centers where physical healthcare is being integrated into the mental health
A key challenge of this initiative is the financial
sustainability of the integrated care practices after the federal support ends.
In this paper, Milliman’s Steve Melek, Katie Matthews, and Ally Weaver present a payment model that they believe would support the sustainability of integrated care practices while also helping payers to control healthcare costs. They look first at commercial payer spending on primary care and outpatient behavioral services and then examine the costs of building and maintaining an integrated primary care practice from the providers’ perspective.
They build their integrated primary care practice using a
“teamlet” approach. Their design also addresses the primary care physician
shortage by adding a nurse practitioner and physician assistant to the
integrated primary care practice. It includes medical assistants and licensed
practical nurses to complete the medical team.
What has happened to utilization and costs for mental health and substance use disorder benefits as the mental health parity laws and associated rules were slowly rolled out? This paper by Milliman consultants presents an analysis of healthcare utilization and cost patterns during the six-year period from 2008 through 2013 and suggests that the Mental Health Parity and Addiction Equity Act has driven increases in access to, and benefit richness for, mental health and substance use disorder benefits.
Nonquantitative treatment limitations (NQTLs) continue to be a source of difficulty for many health plans in attaining compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Now that a few years have passed since the implementation of the final rules, we can see examples of MHPAEA enforcement related to NQTLs and the types of NQTLs being investigated and settled. In this paper, Milliman consultants provide perspective.
The U.S. Departments of the Treasury, Labor, and Health and Human Services issued final regulations on November 8, 2013, implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Although interim final rules (IFR) had been in effect since 2010, the industry has been awaiting these final rules in order to gain clarity on how to comply with certain provisions of MHPAEA.
The new rules clarify or revise some aspects of the IFR that had created unusual consequences for employers and health plans. They also make several important changes to the rules regarding nonquantitative treatment limitations (NQTLs); however, a number of important elements of the IFR, such as the basic framework for testing compliance on financial requirements and quantitative treatment limitations, were left unchanged. This briefing paper authored by Steve Melek presents the key changes to the regulations codified in the final rules and discusses the implications for employers and health plans.
For an overview of the 2010 IFR, see the Milliman healthcare reform briefing paper, “Implementing parity: Investing in behavioral health.”
Stephen Melek and Michael Halford’s research paper “Measuring the cost of undiagnosed depression” appeared in the July/August 2012 issue of Contingencies.
Despite the high cost and prevalence of depression, it is often either undiagnosed or not diagnosed in a timely manner, and diagnosis does not always lead to treatment. While the costs of depression after the diagnosis of the condition have been widely studied, literature on the healthcare costs and absence-from-work costs during the period between initial disease onset and subsequent diagnosis and treatment is not as robust.
New research estimates the excess healthcare costs and absence-from-work costs during the two-year period prior to the initial diagnosis of depression. This research indicates that the total excess healthcare costs and absence-from-work costs for persons with undiagnosed depression over the two-year period leading up to the depression diagnosis/treatment is approximately $3,386 per undiagnosed depressed individual (in 2009 dollars). The report includes a discussion of what these findings mean for employers and insurers.
Download and read the article here.