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Reading a magazine, I saw an ad for the book “Thrive: How Better Mental Health Care Transforms Lives and Saves Money.” The title obviously piqued my interest and I’ve picked up the book. With detailed statistics, data and analysis, the authors make a strong case for better funding of mental health care. Most particularly, they clearly demonstrate that it is way more expensive to not pay for mental health care than to pay for it. Quoting from page 11 (didn’t take long to get to the heart of it): “It turns out that mental health has a huge effect on physical health, and thus on health care costs. … Controlled trials show that if you get psychological therapy, you go to the doctor for physical ailments much less often than those who remain untreated. The resulting savings are large enough to fully cover the cost of the psychological therapy.” [1] What’s that? You go to the doctor less often for physical reasons if you have received appropriate mental health care? This makes sense as it’s common knowledge that there’s a link between mental state and recovery from physical ailments. How many blogs, like this one, have you read about attitude mattering when battling cancer? The problem is the way our health care and mental health care payers have structured reimbursement. The system is rigged. Many of our insurers use a mental health “carve-out.”[2] If you’ve ever sought coverage for counseling or psychological treatment, you are probably aware that your primary health care insurer (someone like Blue Cross Blue Shield) actually refers you to someone else for mental health care claims and pre-approvals (someone like Optum). This system creates the situation where each insurer is held accountable for keeping costs down in their sector of care. The fact that overall costs are dramatically reduced by providing mental health care becomes invisible. It appears cheaper to deny claims and coverage. In “Thrive,” the authors go on to support with facts and figures, the efficacy of treatments like Cognitive Behavior Therapy (CBT) is low cost for many of the most prevalent illnesses: depression and anxiety disorders. In fact, CBT is successful 50% of the time over the course of only 16 sessions at an average cost of $2,000! This pokes a very large hole in the justification for carve-outs – that these illness are chronic and open-ended and therefore very costly to treat. Of course, there are chronic, long term mental illnesses. But if treating mental illness reduces physical illness, at a rate that pays for mental health care, then the bottom line is that it’s cheaper for insurers to pay for mental health care than not. So why aren’t they? At a minimum the practice of carve-outs creates an environment where it’s hard to see the holistic financial benefits to insurers. This may be why many insurers are stalling on paying claims as required under the Mental Health Parity and Addiction Equity Act passed in 2008. We can only assume they think it’s cheaper to ignore the law than abide by it. Reading “Thrive,” has illustrated to me that's not the case. 60 Minutes did a segment on mental health claim denial rates in December 2014, 6 years after the law was passed. Now we’ve been waiting for eight years. It never made sense morally (it's the law after all), but now it's clear there's really no excuse. So what can you do? Get the message out that parity is cheaper than denying mental health claims. Connect with The Kennedy Forum who is working to ensure the full implementation of the Parity Act. Find out how your state is doing in implementing parity. Speak out on Facebook & Twitter by sharing this blog and ParityTrack.org. Raise your voice to demand parity on both the state and federal levels. Cheaper and better – now that’s a win-win. [1] Layard, Richard & Clark, David M. Thrive: How Better Mental Health Care Transforms Lives and Save Money; Princeton University Press, Copyright 2014. Page 11
[2] Carve-out: a service not covered in a health insurance contract. It is usually reimbursed according to a different arrangement or rate formula than those services specified under the contract umbrella
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