Parity Problems: Study Shows Gap in Coverage for Behavioral Health Worsens

Despite government efforts to promote parity in healthcare coverage, a study published Wednesday shows a growing disparity in-network use and provider reimbursement for employees and their families seeking mental health and addiction treatment versus those seeking treatment for physical health conditions.

The study, commissioned by the Bowman Family Foundation and published by Milliman Inc., is based on claim data from 2016–17 in all 50 states “for hundreds of health insurance plans” that cover 37 million employees and their dependents, according to a news release. Among the other findings included in the report:

• In 2017, out-of-network use for behavioral health was 520% more likely than for medical/surgical, up from 280% in 2013.
• Inpatient out-of-network use for substance use disorder treatment was 1000% more likely than for medical/surgical care in 2017, up from 470% in 2013.
• Reimbursement rate disparities for substance use disorder office visits compared to primary care office visits increased each year from 2013­–17.
• Behavioral health visits for youths were 10 times more likely to be out of network in 2017.

“The study’s findings are beyond disappointing and disturbing,” Henry Harbin, MD, a psychiatrist, former CEO of Magellan Health Services, and advisor to the Bowman Family Foundation, said in the release. “With the extensive efforts by multiple stakeholders, over the last several years, we were expecting to see significant improvements. Instead, we are going backwards.”

Action items

The report details a series of action items it recommends in light of its findings:

• Implementing priority strategies, including improving network access for behavioral health specialists, expanding collaborative care to integrate behavioral health into primary care, expanding tele-behavioral health services, and implementing measurement-based models of care.
• Federal and state regulators increasing parity oversight by requiring payers to provide more detailed data on out-of-network use, reimbursement, denial and preauthorization requirements.

The authors of the study also encourage payers who believe the data in the report is not indicative of their health plans to publicly release their data.