Tag Archives: Steve Melek

Impact of Mental Health Parity and Addiction Equity Act

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 in the spotlight

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 final rules for the Mental Health Parity and Addiction Equity Act of 2008

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.”

Milliman analysis of depression costs published in Contingencies

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.

Can state Medicaid programs experience savings through medical-behavioral integration?

When it comes to Medicaid costs, a single percentage point can have billion-dollar implications. Medicaid managed care premiums increased only 1.0% to 2.0% on average in recent years. This increase in premiums amounts to $36.5 to $41.9 billion over 10 years in total, with the state governments funding $13.0 to $14.9 billion. Reducing costs by even a tenth of a percent has significant implications for Medicaid, which is why increased behavioral health deserves consideration.

Milliman’s Stephen Melek’s new research paper, Bending the Medicaid healthcare cost curve through financially sustainable medical-behavioral integration, recommends providing more behavioral healthcare services to Medicaid beneficiaries, not fewer, through integrated medical-behavioral healthcare programs.

The paper also presents some data to assess the value opportunity for doing this integration, discusses the language of integrated/collaborative care, addresses the challenges in achieving financially sustainable integration models, and looks at recent innovations and pilot programs that are focused on delivering better healthcare, attempting to achieve better clinical and financial outcomes, and providing input for the case that medical-behavioral integration innovations can work well.

The entire research paper can be downloaded and read here.

Also, for more Medicaid insight from our experts, see here.

Measuring the cost of undiagnosed depression

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.

The purpose of this research is to estimate the excess healthcare costs and absence-from-work costs during the two-year period prior to the initial diagnosis of depression. We estimate 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).

To see the full results, including data sources, study methodology, and a discussion of what these findings mean for employers and insurers, click here.