A recent study compared patients' out of pocket
costs for behavioral health to conditions such as diabetes or congestive heart
failure.
People who need
behavioral health treatment often need to go out of their insurance plan’s
network to receive care, and as such, they typically shell out more in
out-of-pocket costs than those with other types of ailments, according to a study posted on
JAMA Network Open.
The researchers,
led by Wendy Yi Xu, an assistant professor of health services management and
policy at The Ohio State University, examined commercial insurance claims from
3.2 million adults with mental health conditions, more than 321,500 with drug
use disorders and more than 294,500 with alcohol use disorders. They compared
those with claims from people with one of two common chronic conditions—diabetes
and congestive heart failure.
Key findings
include:
·
Those with drug-use disorders were almost 13 percentage points
more likely to have out-of-network hospitalizations and more than 15 percentage
points more likely to experience out-of-network outpatient care than those with
congestive heart failure.
·
Enrollees with mental health conditions had cost-sharing
payments for out-of-network care that were $341 higher per year on average than
enrollees with diabetes.
·
Compared to people with diabetes, those with drug-use disorders
paid $1,242 more per year on average for out-of-network care and those with
alcohol-use disorders paid $1,138 more.
“Much of this
disparity is likely due to the limited availability of behavioral health care
providers in insurance plans—the participation rates by these providers are generally
low, a problem that is fueled in large part by low reimbursement rates for
clinicians, including psychiatrists,” Xu writes in the university’s blog post
about the study. “We saw that people with heart failure and diabetes
didn’t go out of network as often and didn’t pay nearly as much for their care,
probably because they were able to find care within the network,” she writes.
Cost sharing for
out-of-network care represents “a substantial financial burden” to patients
with behavioral conditions, “and it may be an important sign of network
inadequacy that requires more scrutiny from policy makers,” the study
concludes.
Policymakers
apparently agree—both public and private.
On the same day
(Nov. 6) the study was published, the Centers for Medicare & Medicaid
Services announced the approval of a “first-of-its-kind Medicaid” demonstration
project that broadens treatment services available to Medicaid beneficiaries
living in the District of Columbia diagnosed with serious mental illness and/or
serious emotional disturbance. At the same time, CMS is approving the
District’s request to begin providing new services for its beneficiaries
diagnosed with substance use disorder.
“For too long, our
system has failed to provide Americans with serious mental illness and their
families the treatment and assistance that they need,” HHS Secretary Alex Azar
writes in the CMS press release. “Americans with serious mental illness too
often end up homeless or in our prisons, when access to treatment could help
them lead healthy lives.”
Improving access to
behavioral health services is also top of mind for private payers, according to
Health Payer Intelligence. For example, Blue Cross Blue Shield of Rhode Island
is partnering with Bradley Hospital in East Providence to mitigate pediatric
psychiatrist shortages in their region.
“A non-for-profit
in the Lifespan health system in Rhode Island, Bradley Hospital hosts the
PediPRN initiative, which provides a consultation team of child psychiatrists
to provide telehealth support to pediatric primary care providers,” HPI writes.
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