Hope and Healing for Mental Illness is Possible Accountable, Accessible, Affordable Care Reduces Hardship — and Costs PATH TO A STIGMA-FREE WORKPLACE Published with permission from the National Alliance of Healthcare Purchaser Coalitions.
“There is no health without mental health; mental health is too important to be left to the professionals alone, and mental health is everyone’s business.” — Dr. Vikram Patel
It’s common knowledge that early detection and appropriate treatment of medical conditions can considerably reduce hardship and costs. Yet with mental health conditions, patients who seek help may wait months — even years — for a diagnosis, and even longer for an effective personalized care and medication management plan. Mental health conditions are the leading cause of disability worldwide. In the U.S., about one in five adults will experience mental illness in a given year, 60 percent of whom don’t get help. Many who do reach out face a daunting labyrinth of high costs, a dearth of providers, and unsuccessful treatment, leading to waning motivation, hopelessness, and progressively worse symptoms. Adding to the challenges, only 55 percent of the nation’s psychiatrists accept insurance, compared with 88 percent of physicians in other medical specialties. The difficulty in finding in-network mental health providers extends to other mental health professionals, too. It’s getting worse. The nation needs to add 10,000 providers to each of seven mental health professions by 2025 to meet the expected growth in demand. The lack of access has created a crisis throughout the healthcare system that is costly, harmful and frustrating — sometimes catastrophic — for patients, their families, and other healthcare providers. With unmet patient needs soaring, pressure on hospital emergency departments is untenable and quality and satisfaction levels are alarmingly compromised. Action Steps for Employers: The barriers to achieving the mental health system we need are many, but they are surmountable when payers and purchasers work together to drive long-overdue change such as: • Requiring independent validation of mental health parity compliance. • Evaluating and dealing with root cause issues related to in-network access to mental health professionals. • Promoting the Collaborative Care Model to improve mental health access and quality through primary care. • Supporting access to a full complement of mental health medication options to yield improved outcomes and lower overall costs. • Developing innovative strategies 4
1 IN 5 American adults has a mental illness
Mental illnesses are the leading cause of disability worldwide
1 in 10 full-time employees has an addiction
DID YOU KNOW? gaps by working closely with their health plans and other vendors to offer and pro The nationwide rate of current motecigarette things likesmoking EAPs, telemental among health, pharmacogenomics, online beadults with past year cognitive any mental illness (AMI)resiliency is 31.6% vs. havioral therapy (CBT), and without AMI. second opinion stress18.7% reduction training, services, and more. About 10% of pregnant women
and 15% of postpartum women
Personalized Treatment experience depression.
By their nature, medications for mentalhealth do not work consistently Anxiety disorders, the mostfor all common mental patients like statins dohealth for people with 18.1% (42 high diagnosis, cholesterol. affects Mental health treatment of employees with a more than 35% of million) American adults. is complex, and studies show that medicamental illness take time managers feel they off because of it— receive no formal tions in the same class for the treatment of About 90% of people who die up to 10 days a year support or resources to mental illness are not interchangeable the by suicide—the 10th leading help employees way cause medications in other classes may be. of death I the U.S.—have Policies that include overly restrican underlying mental illness. tive formularies (e.g., excluding newer mental health the workplace medicines), prohibit clinical exemptions to support, engageinand advocate for em- RESOURCES reduce disparities FOR and improve access and (e.g., mental Right Direction program, based on cost rather than science, or inployee health and well-being. EMPLOYERS: outcomes for mental health services. They stitute onerous prior authorization or step should examine by location: RESOURCES FOR IWILLLISTEN, In Our Own Voice) • Addiction andenough mentalnetwork health vs. therapy requirements can fail to achieve Ensure Parity Compliance • Are there providers EMPLOYEES: Ensuring disparities their intended purpose of reducing overall It’s been return-to-work nearly a decadepolicies since Conbyphysical specialty?health: What Analyzing is the wait time for first • National Alliance on Mental Illness include accommodations and cohealthcare costs. These practices can pogress passed the Mental Health Parity appointments? in network use and provider tentially delay or hinder full recovery, andworker Addiction Equity Act of 2008, which • How is the plan attracting and reeducation. • Mental Health First Aid at Work lead reimbursement rates (Milliman longer periods of disability and lower promised to make mental health and subtaining providers? How are alternative • toRight Direction report) The easy steptreatment of removing productivity, and contribute to additional stance abuse as arbitrary easy to get as payment models used to motivate betStamp Out Stigma limits been taken. The harder visits and even hospitalizations. care forhas any other condition. But despite •terMoving access,Mountains improved quality, andHealth better • medical for Mental When it comes to mental health and suban opioid epidemic that is causing 91 value? If so, how is value defined? steps of ensuring true overall parity, and Well-Being (Article by Michael ENDNOTES: stance abuse, the standard of treatment deaths a day, and suicide rates that have • What percentage of medical claims appropriate in-network access, and Thompson, National Alliance 1. today https://www.nami.org/Learn-More/Mental-Healthis that physicians and patients work surged to a 30-year high (with mounting were paid for medical and surgical care dealing with the persistent issues By-the-Numbers president and CEO) together to define individualized treatment disparities between rural and urban comout-of-network vs. for mental health/sub2. https://www.ncbi.nlm.nih.gov/pmc/articles/ related to payment, outcomes and stigma decisions consistent with medical guidemunities), accessing mental health care •stance abuseWell: disorder (MH/SUD)? What PMC3967759/ Working Leading a Mentally remain. difficult Employers can take lines and personalized circumstances. remains for many, andpositive impossible is your plan to reduce disparities? 3. http://www.modernhealthcare. Healthy Business (a comprehensive com/article/20161231/ actions There are emerging trends showing for some.on their own to make it better but • How is mental health prevention TRANSFORMATION03/161229942 toolkit for employers, including promise for improving first-time prescriblevels related to benefit levels promoted? Are pregnant and post-partum will Parity also need to work together, uniting 4. http://www.cnn.com/2017/04/24/health/opioidmental health programs for the ing success and medication compliance. are generally well andthat have women and smokers screened for depresdeaths-cdc-report/index.html the purchaser voiceunderstood and insisting workplace) For example, pharmacogenomics uses generally been implemented by health sion? Do you promote and reimburse for 5. https://www.nytimes.com/2016/04/22/health/usstakeholders deliver on the promise— suicide-rate-surges-to-a-30-year-high.html information about a person’s genetic plans, behavioral health organization mental health and substance abuse screenand obligation—of effective mental Out-of-Network, Out-of-Pocket, Out6. makeup http://www.milliman.com/ to choose the drugs and drug and plan sponsors. However, parity re- •ings? NQTLDisparityAnalysis/ health care for all. to “non-quantitative of-Options: The Unfulfilled Promise that are likely to work best. While quirements related • Do providers use a validated, stan- 7. doses https://www.rwjf.org/en/library/research/2011/02/ of Parity (NAMI report) relatively new, the potential to avoid multreatment limitations” (e.g., utilization dardized instrument to monitor progress mental-disorders-and-medical-comorbidity.html 8. tiple https://www.ncbi.nlm.nih.gov/pmc/articles/ initial and subsequent therapy fails management, medication management, and outcomes for specific conditions. PMC3628173/ and incorrect diagnoses can be mitigated. etc.) are much more complex. Plan sponIn addition, not complying with mensors have a fiduciary responsibility to enCollaborative Care Model tal health medication therapy can lead to sure compliance and would be prudent With responsibility for providing serious consequences such as relapse, hosto require their administrators to obtain mental health care falling increasingly to pitalization, incarceration, suicide, and independent assessment/accreditation of primary care providers (PCPs), and more poor quality of life. With today’s techthat compliance. than 68 percent of adults with a mental nology, we have “smart” pill bottles, disorder having at least one medical conNational Alliance would like to acknowledge the support it hasmobile apps, multi-dose delivery, and Evaluate Network dition, the Collaborative Care Model has received from APA Foundation Center for Workplace Mentalnewly FDA-approved ingestible pill sensors to Management the most evidence among integration modHealth, Clearview Health Quality Institute, and Takeda/Lundbeck aid compliance. From a quality and affordability els in controlling costs, improving access, Pharmaceutical perspective, issues related to access to inimproving clinical outcomes,Alliance reducingin the form of clinical expertise and to produce this ActionSupport, Brief. Engage, Advocate network mental health services can go stigma, andfunding increasing patient satisfacProgressive employers understand beyond the parity requirements. Among tion. Given the shortage of mental health DECEMBER that in a workplace culture where 2017 menthe findings in a November 2017 report providers, the system can be improved tal illness isn’t stigmatized — and seeking published by Milliman Inc.: significantly when patients with mild to help is encouraged and supported — em• In 2015, behavioral care was four to moderate mental illness rely on PCPs to ployees are more likely to be aware of and six times more likely to be provided outcoordinate and manage their care. A Coluse available resources such as EAPs, so of-network than medical or surgical care. laborative Care team is led by a PCP and they can start treatment sooner and re• Insurers pay primary care providers includes care managers, psychiatrists, and cover more quickly. And treatment works, 20 percent more for the same types of care other mental health professionals. Workeffectively reducing symptoms for 75 peras they pay addiction and mental health ing with vendors, employers can ensure cent of those with common mental health care specialists, including psychiatrists. that employees and their covered family conditions like depression and anxiety. • State statistics vary widely. In New members benefit from this Model. Just as with physical medical condiJersey, 45 percent of office visits for behavInnovation can also mitigate the actions, mental health outcomes improve ioral health care were out-of-network. In cess issues. High-quality, cost-effective, when illness is caught early in the most Washington D.C., the figure was 63 perevidence-based solutions that are approtreatable stage, and patients receive the cent. priate for the patient’s condition across care and support they need to get well. Plan sponsors need to set expectations the continuum of acute and chronic care (CONTINUED ON PAGE 6) for their health plans and other vendors to are available. Employers are bridging care
HR managers know the toll mental illness can take on the company. Yet, only 15% feel managers are training to recognize the problem and share support and resources
West TN Medical News March 2018