Catalyst for Payment Reform

Mental Health Care is Evolving. So Are Purchasers’ Strategies.

Mental Health Care is Evolving. So Are Purchasers’ Strategies.

If ever there was a worldwide phenomenon that perfectly captured the concept of “two sides of the same coin” it would be COVID-19. The pandemic exploited the weaknesses of our health care system while simultaneously highlighting under-utilized technologies like telehealth. It took away our ability to travel and see the world, while also helping us see the value of what we have at home. Likewise, it brought about a tsunami of mental health challenges, but in doing so, revealed that these challenges can affect everyone, are not unique, and require effective and thoughtful solutions.

Observed in the U.S. since 1949, May is Mental Health Awareness Month. But this time around, it feels a bit different, especially from the purchaser point of view. While mental health care has long been a focus for CPR members and other employer-purchasers, never has there been a more pressing need for access and benefits addressing it. CPR efforts to bring purchasers together to discuss challenges and opportunities in mental health validate that purchasers are taking a deeper dive into mental health, expanding their offerings and considering important areas of focus such as pediatric mental health care and health equity. When evaluating a potential program or improving an existing one, here are key aspects every employer should consider:

Variety and accessibility matters.

  • Consider the different types of mental health providers (e.g., psychiatrists, psychologists, and licensed clinical social workers) in your network(s). Also, understand which providers offer in-person mental health services, virtual mental health services, or both.
  • What digital mental health treatment options are or would be available to members (e.g., cognitive behavioral therapy apps, self-screening tools, stress management resources, etc.)?

Are you measuring quality?

  • Are quality measures related to process of care, patient outcomes, and patient experience with mental health care being tracked and reported?
  • Is it possible to analyze access, quality, and utilization data for mental health care by age, race, ethnicity, income, and gender?
  • Do network providers use a standard set of mental health screening tools (e.g., General Anxiety Disorder (GAD) Screener, Depression Anxiety Stress Scale (DASS), Revised Children’s Anxiety and Depression Scale (RCADS), etc.)? Is the use of these tools measurable?

Let’s talk money.

  • Are mental health providers being paid competitive rates for their services? Do you have insight into what the health plan pays and whether it’s sufficient for an available network of providers?
  • Is it possible to offer providers additional incentives to participate in the network? For example, payment for continuing education could encourage more providers to participate.
  • Are you encouraging your health plan to implement value-oriented payment methods (i.e., incentive payments that rewards a provider for achieving quality targets) with mental health providers?

Equity is at the heart of success.

  • While there has been improvement in general awareness and acceptance, purchasers must still consider ways to combat different types of stigma associated with seeking or receiving mental health services. Some of these include stigma stemming from workplace culture (e.g., perception of not being able to handle the job), cultural and social (e.g., gender) norms, profession-specific expectations/assumptions (e.g., front line workers hesitance to seek assistance as they are supposed to be the ‘strong ones’), and work-from-home challenges.
  • Are you considering ways to address structural racism, health care and outcomes disparities, and inequity in mental health care? These can include programs to increase provider training in implicit biases, culturally competent care, and addressing racial trauma – the mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes.
  • Is your health plan and/or its contracted providers considering establishing partnerships or affiliations with Black, Indigenous and people of color (BIPOC) led organizations?
  • Are you considering designing and implementing programs to build member trust, particularly for plan members experiencing inequities?
  • What percent of total mental health network providers are BIPOC? What percent of prescribing and non-prescribing mental health network providers are BIPOC?
  • Lastly, what are some ways to increase the diversity of your provider network (e.g., providing paid opportunities for clinical training)?

This May, take a fresh look at your mental health strategy or design a new one based on these principles in order to provide a program to your members that grants access to a variety of providers and treatment options, measures quality of care, pays for value, and makes equity a priority.

CPR’s Assistant Director of Projects and Research, Lea Tessitore, MBA, MSB, wrote this blog. As a bioethicist, Lea uses her unique perspective and formal principles of health care ethics to inform CPR’s work.

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