Taking A Stand For Better Mental Health: 5 Trending Health Plan Strategies

Across all types of health plans—government, Medicare, Medicaid, CHIP, Medicare Advantage, commercial, and employer—payers are focusing on enhancing mental healthcare for their members. In addition to adopting strategies to increase covered provider types, embrace telehealth, and participate in more value-based care payment models, we've observed health plans acting on 1 or more of the following 5 trends to address the current mental health crisis.

5 payer themes reflect mental health priorities

Recently, AHIP released a summary of what 40 payers are doing to “stem the tide of the mental healthcare crisis in the US." Strategic themes emerged that highlight how health plans are improving access, supporting primary care, and looking to the future while meeting the need for emergency mental health.

Payer focus #1: Expanding behavioral health integration

By expanding access to a wide range of mental health professionals and growing networks, health plans are equipping primary care providers (PCPs) with operational guidance and training to integrate behavioral healthcare into their practice.

Research conducted by AHIP highlights other ways that insurers are supporting primary care:

• 72% of health plans are training and supporting PCPs to care for patients with mild or moderate behavioral health conditions
• 72% of plans are assisting PCPs with finding behavioral health specialists for referrals
• 56% of payers are offering PCPs telehealth or telephone consults with behavioral health specialists

One example is Anthem's child psychiatry consultation program, which connects PCPs with child psychiatrists. The Collaborative Care Model (CoCM) is another opportunity for health plans to work with primary care partners, using an evidence-based model that integrates care management, a patient-centered team, and measurement-guided care plans. Payers can fund initiatives to expand CoCM, or other behavioral health integration models, or make digital tools and platforms that support behavioral health integration available to network providers.

In addition to supporting greater access through primary care, health plans are using a multichannel approach by partnering with pediatric care managers, school districts, and community-based organizations. The Department of Health and Human Services (HHS) is currently investigating models of care to test new behavioral health pay-for-reporting and pay-for-performance mechanisms that would leverage integration-related quality measures.

Payer focus #2: Broadening team-based approaches

Possibly in support of a transition further into value-based care arrangements, health plans are expanding involvement with team-based mental healthcare. This approach leverages care managers who coordinate across multiple providers, aligning and integrating care delivered by numerous providers to support individuals with chronic conditions, particularly behavioral health conditions. Payers engage a range of specialties that can include primary care providers, pediatricians, care managers, psychiatrists, and specialty pharmacists.

This type of team-based care focuses on early diagnosis, risk assessment, timely interventions, and consistent follow-up care.

Payer focus #3: Developing and incentivizing the workforce pipeline

Research and analysis conducted by the Kaiser Family Foundation (KFF) looked specifically at how state Medicaid agencies would not only increase rates and incentivize network participation by current approved providers but how they are extending the workforce by adding peer or family specialists as providers. Or, as New Jersey now allows, social workers can bill Medicaid directly. Commercial payers may follow moves like Blue Cross of Minnesota which announced it will cover peer support specialists starting in 2024.

However, health plans look not just at the near term but to the future, creating a pipeline for tomorrow's mental health professionals. Health plans are also addressing the mental healthcare workforce shortage. For example, UCare funded $100,000 towards clinical intern stipends, reducing the financial barrier for individuals seeking to join the mental healthcare workforce. A new pilot program will support students in training and licensing for social work, clinical counseling, and other forms of mental healthcare.

Additionally, Aetna partnered with Psych Hub, training 283,000 behavioral healthcare providers, employee assistance program providers, Aetna internal clinicians, and CVS Health Minute Clinic counselors to provide suicide prevention and intervention for young adults and adolescents.

Complementing what health plans are doing directly, HHS is pursuing opportunities to recruit, train, and support a diverse behavioral health workforce, including projects like these:

• The Substance Abuse and Mental Health Services Administration (SAMHSA) is creating a training pipeline from Historically Black Colleges and Universities, Minority Serving Institutions, and other higher education institutions that reach underserved populations.
• SAMHSA is expanding its Mental Health Awareness Training program that provides training and preparation to ensure appropriate and safe responses to individuals with behavioral health needs, particularly those with serious mental illness or serious emotional disturbance.
• Massachusetts has a new CMS-approved 1115 demonstration extension where the state can oversee behavioral healthcare student loan repayment to address workforce shortages.
• The Indian Health Service (IHS) is developing strategies to recruit, train, and support a diverse behavioral health workforce through integrated settings, including community health workers and peer support specialists. The IHS Scholarship Program, their Loan Repayment Program, and the American Indians into Psychology Grant Program all support the goal to increase the number of providers serving American Indian and Alaska Native people.

Behavioral health peer support certification

Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Office of Recovery, and HHS published new national standards that allow for behavioral health peer support through certification. HHS and SAMHSA's recent peer certification guidelines elevates the entire peer support services conversation and may provide momentum for states to create advanced levels of certification or specialty child/adolescent certification, which could help fill workforce gaps in the pediatric behavioral health space.

Payer focus #4: Decreasing provider burdens

Reimbursement rates are essential to attracting providers to a payer's mental health network. However, other barriers are just as challenging, including administrative burdens and lack of standardization across health plans. The aforementioned analysis found that varying administrative requirements may be particularly difficult for smaller behavioral health provider organizations.

For Medicaid managed care organizations (MCO) that rely heavily on behavioral health providers, KFF's research found that about 75% of states are prioritizing decreasing administrative burdens in fee-for-service and MCO relationships. Other Medicaid strategies to reduce provider burden include:

• Engaging behavioral health (BH) providers for their feedback
• Streamlining behavioral health documentation
• Centralizing/standardizing provider enrollment and credentialing
• Standardizing clinical or treatment plan forms
• Standardizing initial unit numbers for prior approved services

These same approaches are prioritized by commercial and employer-owned health plans that want to attract more providers across all types. These organizations recognize that initial and ongoing administrative burdens are a significant barrier for behavioral health professionals.

Payer focus #5: Supporting crisis services and prevention

The launch of the 988 Suicide and Crisis Lifeline in 2022 provided US residents access to a network of over 200 local and state-funded crisis centers through federal mandate. This was a significant move to support individuals and create an access pipeline for mental health help. Additional legislation that was passed as a part of the Consolidated Appropriations Act seeks to improve coordination, standardization, and evaluation of the 988 hotline, as well as the overall behavioral health crisis continuum in the US.

Other specific activities through Medicaid, commercial, and employer health plans seek to support beneficiaries and employees in their greatest time of need. One example is Aetna's Caring Contacts program which supports individuals in crisis who had recent suicide attempts. They are implementing a comprehensive strategy with the goal of reducing suicide attempts by 20% among Aetna members by 2025.

Medicaid works to fill gaps in care

As the country's single largest payer of behavioral health services, Medicaid is working to shore up mental health crisis and intervention services. A study announced by KFF in May revealed that behavioral health crisis services are a gap in care:

• 75% of states do not cover all 3 core crisis services for adults under fee-for-service Medicaid, but most states cover at least 1 core crisis service
• 50% of states are actively pursuing or plan to implement the American Rescue Plan Act (ARPA) mobile crisis intervention services option
• Almost all states reported at least 1 obstacle to implementing crisis services, including workforce shortages and geography-based challenges

Employers and self-sponsored plans expand benefits

While private insurance may take a different tact toward addressing behavioral health through employee assistance programs (EAPs), teletherapy services, and 24/7 support lines, the goal is the same–to help individuals navigate life and work situations that affect health.

And the commitment is continuing. Two out of 3 US employers have made employee mental health 1 of their top 3 health priorities between 2022 and 2025. Also, the number of employers offering designated mental health days could more than triple from 9% to 30% by 2024.

The survey of over 450 employers by Willis Towers Watson revealed their near-term focus, including:

• Nearly all offer an EAP
• 88% have taken measures to address workforce mental health
• 83% offered telebehavioral health
• 69% provide dedicated onsite or virtual EAP resources
• 38% partner with employee resource groups to address population-specific mental health issues
• 24% plan to increase EAP benefits by 2025

Health plans continue their commitment to mental health

These trends reflect payer priorities to expand and address mental health needs. RTI Health Advance is experienced in helping healthcare organizations identify where best to invest resources to support the specific needs of their members.

Our team comprises clinical, health policy, population health, digital therapeutics, data science, quality, and health equity experts. Together, we deliver evidence-based, practical insights and solutions for clinical, business, and programmatic leaders to achieve their most pressing care, quality, and financial objectives. Contact us today.