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Mental health parity: U-M experts available
EXPERTS ADVISORY
This week, President Joe Biden announced a set of proposed federal rules aimed at ensuring that people with mental health conditions receive similar insurance coverage for needed care as they would for physical health conditions.
The rules, if enacted after a 60-day public comment period that will begin soon, would seek to ensure the parity between the two types of care that was the core goal of a previous federal act.
Many people and families with mental health conditions still find that they cannot find mental health care providers who have capacity for additional patients and/or who are in-network for their health insurance. Some who are able turn to paying out of their own pockets for mental health care instead of billing insurance.
A national shortage of mental health care providers and a rise in diagnosis of mental health conditions exacerbates the issue.
The following University of Michigan experts are available to comment:
Srijan Sen is director of the Eisenberg Family Depression Center and the Frances and Kenneth Eisenberg Professor of Depression and Neurosciences at the U-M Medical School
“I think the specific proposed changes are worthwhile, most notably reducing prior authorizations and gathering data,” he said. “But I do think the impact of these changes will be limited without concurrent changes to expand the capacity of our mental health care system.”
Contact: Kara Gavin, kegavin@umich.edu, 734-764-2220
Mark Fendrick directs the Center for Value Based Insurance Design and is a professor of internal medicine at the Medical School who studies how individuals choose to spend money on the health care they most need, and the impact of insurance policy requirements and federal rules on such spending..
“Numerous studies have demonstrated that even modest levels of out-of-pocket cost are associated with lower use of clinically necessary, high-value mental health services and treatments,” he said. “Further, these reductions can lead to downstream consequences including worsening of illness and increased need for acute care and hospitalization. Parity in insurance coverage can address the need to balance appropriate access to essential mental health services with growing fiscal pressures faced by public and private payers.”
Contact: Kara Gavin, kegavin@umich.edu, 734-764-2220
Joanna Quigley is the associate medical director for child and adolescent outpatient psychiatry and addiction treatment at Michigan Medicine, and a clinical associate professor of psychiatry.
“Moving true parity for mental and behavioral health care continues to be elusive for many, and interventions that remove barriers during a time of unprecedented demand for mental health care, are welcome,” she said.
Contact: Kara Gavin, kegavin@umich.edu, 734-764-2220
Victor Hong is the director of psychiatric emergency services at Michigan Medicine and clinical associate professor of psychiatry.
“For many years, clinicians, hospital systems and most importantly, patients, have suffered the consequences of continued lack of mental health parity, despite there technically being a law enforcing this issue,” he said. “Any new laws and/or amendments to the law require input from all stakeholders, to ensure that common sense, practical, comprehensive legislation can be forthcoming. Importantly, these laws need teeth sufficient enough so that the penalties for payors motivate changes in their behavior.”
Contact: Kara Gavin, kegavin@umich.edu, 734-764-2220
Chad Ellimoottil is the medical director of virtual care for Michigan Medicine, assistant professor of urology and lead author of a report on telehealth in Michigan commissioned by the Michigan Health Endowment Fund and the Flinn Foundation:
“Our recent report on telehealth use in Michigan showed that half of all Michigan counties have less than 10 mental health specialists, and 1 in 5 Michigan counties have one or no such providers,” he said. “In the 38 counties with the most dire shortages, 57% of all visits with such providers take place via telehealth for patients with traditional Medicare, and 47% of all mental health visits were with providers in other counties. These data show that telehealth meant greater access to mental health care for people living in areas that lack providers of such care.”
Contact: Kara Gavin, kegavin@umich.edu, 734-764-2220
Briana Mezuk is the director of the Center for Social Epidemiology and Population Health and associate chair of epidemiology at the School of Public Health. Her training and research explore the various ways that mental and physical health intersect throughout life.
She says the new proposed federal rules build on much-needed implementation of core provisions in the 15-year-old Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. It is intended to prevent health insurers from limiting or denying patients seeking mental health care.
“This is an example of the importance of seeing policy change through to implementation,” she said. “The mental health care needs of the U.S. have only grown since the Wellstone Act was passed in 2008, and it is only in the past three years that the regulations it set forth have been implemented. The White House is working to ensure that both the letter and the spirit of the law are followed.
“The vast majority of mental health care in the U.S. is provided by general practitioners, who often lack training in psychosocial interventions that are an important part of living well with mental health conditions. Thankfully, we have evidence-based strategies that use a patient-centered approach to address both mental and physical health in the primary care setting through a coordinated team of nurses, physicians and other professionals.”
Contact: bmezuk@umich.edu
Kyle Grazier is the Richard Carl Jelinek Professor of Health Services Management and Policy and a professor of psychiatry. She is interested in improving access to behavioral health care services by vulnerable populations. Specifically, she conducts research on payment models and their incentives to create and sustain access to high quality mental health services that are delivered through integrating primary care with community systems.
Grazier sees progress and reason for optimism in this latest and other federal proposals in recent years and also knows the improvements meant to repair the current system of mental health care and insurance will take time.
“While there is a general shortage of behavioral health providers, the challenges of finding care are exacerbated by the lack of affordable and available access,” she said. “Even among those who have private health insurance and despite the state and federal parity laws in the past 15 years, group health plans and health insurers that provide mental health and substance use disorder benefits continue to impose less favorable limitations on those benefits than on medical or surgical benefits.
“For the consumer, the out-of-pocket cost for therapy or medication management can be prohibitive, and much more expensive than equivalently complex or time-consuming medical procedures, even if a provider is in an insurer’s network. The stark imbalance between needing care and receiving care has led to a call to respond to the behavioral health crisis.”
Contact: kgrazier@umich.edu
