On Wednesday, the U.S. Department of Health and Human Services (HHS) released the final rule on essential health benefits, which outlines the minimum coverage health insurers must provide customers beginning January 2014. One of the key topics features in the new legislation is the parity mandate for both mental health and substance use disorder benefits, which HHS reports will affect 62 million Americans.
"In the past, nearly 20 percent of individuals purchasing insurance didn't have access to mental health services, and nearly one third had no coverage for substance use disorder services," HHS said.
The mandate builds off the Mental Health Parity Act of 2008 and expands behavioral health coverage to millions of people currently without it. The existing law aimed to nullify caps employers had placed on the types or amount of mental health services workers could access. While it improved health benefits for many people, millions of workers with mental health and/or substance use disorders are still untreated, which leaves employers often unknowingly picking up hefty costs.
The cost of ignoring mental healthcare needs
While employers know offering mental health coverage benefits their agency's workforce and cuts costs, many may not be aware of exactly how much their losing or the extent to which ameliorating behavioral health plan management can actually save.
Between 30 and 40 percent of the U.S. population experience mental health or substance use disorders at some point in their lives, according to the Partnership for Workplace Mental Health. In addition, nearly 10 percent of workforce members are classified as heavy alcohol users. However, roughly two-thirds of people with symptoms of mental and substance use disorders do not receive any treatment for their condition.
The result of this is an indirect cost of $80 to $100 billion per year for employers, which includes missed workdays and diminished productivity often associated with depression and anxiety. Direct costs can be much greater.
"When employees with mental illness are not treated or inadequately treated, employers often end up paying more," Partnership for Workplace Mental Health states.
When workers aren't diagnosed and treated early and correctly, employers are often faced with a buildup of expenses from diagnostic procedures, pharmaceuticals and disability leave. This is because untreated employees seek non-psychiatric inpatient and outpatient services three times more than those who are treated. They attempt to remedy the symptoms of depression or disorder - such as sleep trouble, fatigue and back pain - by visiting primary care practitioners rather than mental care providers.
As a result, individuals who are depressed and don't receive treatment consume two to four times the healthcare resources of other enrollees, the Partnership states.
Incorporate mental health management into employee benefits administration
As the data above shows, the direct and indirect costs of ignoring mental health in benefits administration are too substantial to overlook. In a recent interview with Smart Business, Tom Albert, the manager of Behavioral Health Services at HealthLink, explains how integrating behavioral heath and medical healthcare can help employers better manage sponsored benefits.
"With integration, the health plan's medical and behavioral clinicians collaborate and ensure that individuals and their families have access to care that best meets their needs," he said.
Utilization and case management for behavioral health play major roles in effectively administrating benefits. Utilization oversight ensures members have access to the services they need and that resources are used efficiently to control costs, Albert explains. Case management designates representatives who communicate directly with employees and their dependents to help them navigate healthcare offerings and confront obstacles to treatment access. Essentially, case management helps members stay healthy or regain their health quickly so they can avoid using medical services and missing work for prolonged periods of time.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
