-Addiction Treatment Disparities for Inpatient, Outpatient Facility, and Office Visits are Stark Despite the National Opioid Crisis
-Children’s Use of Out-of-Network Mental Health Office Visits is Ten Times Higher than for Primary Care Office Visits, Double the Disparities for Adults
WASHINGTON, Nov. 20, 2019 (GLOBE NEWSWIRE) -- Disparities between physical and behavioral healthcare for both in-network access and provider reimbursement rates are making it even harder for American families to find affordable and available mental healthcare and addiction treatment according to a new study. The report, published by Milliman, Inc. covering 37 million employees and dependents, and commissioned by The Bowman Family Foundation, reflects that conditions have worsened since a similar study was published two years ago.
The report, “Addiction and Mental Health vs. Physical Health: Widening disparities in network use and provider reimbursement,” shows the gap in disparities for employees and their families seeking mental health and addiction treatment versus treatment for physical health conditions widened in 2016 and 2017. The study, based on actual claim data in all 50 states for hundreds of health insurance plans, demonstrates that “out-of-network” use of behavioral providers is higher than out-of-network use of medical and surgical providers – and the degree of disparity has grown substantially in recent years, despite state and federal efforts to promote parity. The study also documented much lower reimbursement rates paid by insurers to behavioral providers for “in-network” services, with the gap between behavioral versus medical/surgical providers widening.
“The study’s findings are beyond disappointing and disturbing,” said Henry Harbin, MD, a psychiatrist, former CEO of Magellan Health Services, and advisor to The Bowman Family Foundation. “With the extensive efforts by multiple stakeholders, over the last several years, we were expecting to see significant improvements. Instead, we are going backwards.”
“These results are profoundly worrisome in light of the recent decrease in life expectancy in the U.S. population due to so called ‘deaths of despair,’ especially suicide and opioid related death rates. We haven’t had a back to back two-year reduction in life expectancy since 1919 when the nation battled the influenza epidemic. What will it take to make the changes needed to turn this tragedy around?" said Tom Insel, Special Advisor for Behavioral Health to CA Governor Gavin Newsom and former Director of the National Institute of Mental Health.
Key findings from the study can be found here in the Executive Summary beginning at page six of the report, and include:
Out–of-network use disparities for both mental health and substance use
“These access problems are about more than just reimbursements. Our evidence shows that health plans limit in-network providers, do not credential new providers in a timely manner, pay significantly lower rates for in-network care, and apply extreme utilization-review tactics that are not based on medically necessary care,” said Mark Covall, president and CEO of the National Association for Behavioral Healthcare.
Substance use disparities (separate from mental health)
Children versus adults
“When a behavioral health visit for youth is 10 times more likely to be out-of-network than primary care office visits, it’s clear we have a serious crisis on our hands,” said Paul Gionfriddo, president and CEO, Mental Health America.
Reimbursement rate disparities
Spending on behavioral care as a percent of total healthcare spending
“This analysis confirms that the U.S. mental health system is only getting worse, not better,” said Michael Thompson, president and CEO, National Alliance of Healthcare Purchaser Coalitions. “It will not fix itself and we need a course correction that requires the active collaboration of employers, regional coalitions, behavioral health and advocacy experts, health plans and providers.”
“With this report, lawmakers and regulators need to step up their oversight and enforcement of the Federal Parity Law. The consequences of inadequate access to affordable behavioral healthcare can be lethal,” said former Congressman, Patrick J. Kennedy, founder of The Kennedy Forum and chair of Mental Health for US.
As shown below, death rates from mental illness and substance use have escalated over this five-year period (CDC, Dec. 2018):
Immediate Recommended Action Steps: The findings in this report, as well as the prior Milliman Report published in 2017, support the need for significant actions from all stakeholders to address what has been a decade of increasing mortality and morbidity from these diseases. A coalition of leading behavioral health organizations issuing this press release highlight and recommend several key initiatives that could make a large impact immediately:
This press release is issued by a coalition of America’s leading mental health and addiction organizations including: American Foundation for Suicide Prevention, American Psychological Association, American Psychiatric Association, American Psychiatric Association Foundation’s Center for Workplace Mental Health, BrainFutures, Columbia University Department of Psychiatry, Legal Action Center, Meadows Mental Health Policy Institute, Mental Health America, Mental Health Association of Maryland, National Alliance on Mental Illness, National Association of Addiction Treatment Providers, National Association for Behavioral Healthcare, National Council for Behavioral Health, Parity Implementation Coalition, The Kennedy Forum, Treatment Advocacy Center.
About the Report:
The report was developed by Milliman, Inc., an independent actuarial and research institution. In the current study, Milliman researchers analyzed five years of insurer claims data from 2013 to 2017 covering 37 million U.S. employees and family members who receive health insurance coverage from their employer. The study covered all 50 states and D.C. and looked at four categories of treatment settings -- inpatient and outpatient facility services, primary care office visits, and specialist office visits, comparing the level of out-of-network use of behavioral health providers versus physical health providers. The study also examined in-network office visit reimbursement rates, aggregate spending on behavioral health (mental health and substance use care) as a percent of total healthcare spending, and separate disparity details for substance use disorders, children versus adults, and various types of inpatient facilities. The Milliman study does not provide an opinion on whether any particular reimbursement rates are appropriate or fair.
A copy of the full report and tables can be accessed at www.milliman.com/bowman