Organizational prioritization of behavioral health

Behavioral health did not emerge as a top management priority or area of organizational expenditure, indicating an opportunity for greater attention. However, the impact of the pandemic on plan member mental health needs and utilization may increase attention and management efforts in upcoming plan years.

Compliance with parity laws

Almost all payers recognized the importance of the Mental Health Parity and Addiction Equity Act. Many, however, revealed a lack of current compliance with all behavioral health parity expectations, creating the potential for less-favorable benefit restrictions for behavioral health services compared to medical and surgical services.

Network adequacy

Inadequate networks fuel out-of-network use and subsequently may limit beneficiary access through the likelihood of increased out-of-pocket costs for care. More than half of respondents recognized a considerable amount of behavioral health "leakage" of out-of-network service use because inadequate breadth of in-network services for behavioral health.

Level of reimbursement

Low reimbursement rates for behavioral health services were widely recognized as a key barrier in establishing and maintaining behavioral health network adequacy and may be partially responsible for inadequate provider networks. According to survey respondents, 75% of plans anticipate raising rates by at least 6% in the near term in response to reimbursement barriers.

Implementation of telehealth tools

Most plans leveraged telehealth to increase access to behavioral health services throughout the pandemic, and many respondents plan to continue to offer a range of services. In addition, 75% of organizations expect to increase the proportion of behavioral telehealth services offered to members.

Use of value-based payments

Plans reported low use of these arrangements and alternative payment models, with 33% of respondents indicating current use. Low incidence of alternative payment models in the behavioral health space may be attributable to a lack of applicable measures that are outcomes-oriented and therefore translatable to payment evaluation and implementation.

"While survey results indicate that payers have not typically prioritized management and expenditures around behavioral health at the highest level, the public health emergency's exacerbation of the existing mental health crisis has helped to reinforce the importance of these services," the survey report concluded. "Payers are beginning to take steps to increase access to care through improving network and reimbursement adequacy, implementing collaborative care and increasing access to and use of telehealth services.

"New mental health parity legislation will reinforce increased access to behavioral health care as payers undertake efforts to ensure compliance. Interest and expected implementation of value-based coverage for behavioral health services may present opportunities for innovative engagement on behalf of behavioral health stakeholders and may ultimately result in beneficiary access to a broader set of services and therapies."

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