by Jane Anderson
Behavioral health network adequacy and reimbursement continue to
lag behind medical/surgical specialties, a recent Milliman report found, and
although health plans and some employers are aware of those problems, there may
not be simple ways to fix them, industry insiders say.
"It is an artifact in the way behavioral health care
benefits and networks were built — carved out from the physical health care
network," says report author Steve Melek, principal and consulting actuary
at Milliman. "It is a reimbursement issue for sure, and also a care
management issue because of behavioral health care providers being managed more
stringently by the health plans, and then they leave the networks."
The Milliman report found that out-of-network utilization rates
for behavioral health care providers were higher than for medical/surgical
providers every year between 2013 and 2017, and rates increased between 2015
and 2017.
Meanwhile, in-network reimbursement, measured as a percentage of
Medicare-allowed amounts, was lower for behavioral health providers than for
medical/surgical office visits, and the disparity increased between 2015 and
2017, the report found.
Melek says this is one of the most important findings in the
research: "The [reimbursement] gap between behavioral vs. medical/surgical
providers is widening."
Nicole Althaus, chief marketing officer at HealthMine, Inc.,
which provides tools to drive members' health actions, says the disparities
found in the report increasingly are on the radar of both employers and health
plans.
"Improvement is also happening because we are starting to
see plans better utilize their data," including both plan/clinical data
and data related to health behavior, Althaus says. "In almost real time,
issues are being surfaced to get plans to take near real-time action."
To improve access to behavioral health services, some employers
are turning to behavioral health apps, notes Mary Kay O'Neill, a Seattle-based
partner in Mercer's total health management practice. Employers may pay for
these directly, she says, although "it doesn't work for everyone."
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