EXPERTS ADVISORY

The federal government has enacted a set of final 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.

Experts from the University of Michigan and Michigan Medicine can discuss the changes and how they may affect individuals, families, insurers and the health care system, which has made finding and paying for mental health treatment more taxing than other health care needs—and for many people unattainable.

A national shortage of mental health care providers and a rise in diagnosis of mental health conditions exacerbates the issue.

The following U-M 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 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, [email protected], 734-764-2220

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Mark Fendrick, who directs the Center for Value-Based Insurance Design, is a professor of internal medicine at the Medical School and professor of health management and policy at the School of Public Health. He 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, [email protected], 734-764-2220

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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 at the Medical School.

“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. “It will be very important to monitor implementation of these changes, particularly around the goals of limiting the scope of limits set through prior authorization processes and limits on length or type of treatment settings.”

Contact: Kara Gavin, [email protected], 734-764-2220

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Victor Hong is the director of psychiatric emergency services at Michigan Medicine and clinical associate professor of psychiatry at the Medical School.

“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, [email protected], 734-764-2220

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Chad Ellimoottil is the medical director of virtual care for Michigan Medicine, assistant professor of urology at the Medical School 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, [email protected], 734-764-2220

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Briana Mezuk is a professor of epidemiology and co-director for the Center for Social Epidemiology and Population Health 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 federal rules build on much-needed implementation of core provisions in the 2008 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.

“Leaders in the field have argued that there is no health without mental health, and the Wellstone Act seeks to ensure that mental health care is given equal footing to medical care. This is an important milestone in addressing the substantial mental health needs of Americans. However, it is critical to understand that even with these regulations, the mental health care needs of Americans will not be met by specialists alone—there are simply not enough psychologists, psychiatrists and social workers, particularly in rural and underserved areas, to meet this need.

“Instead, the vast majority of mental health care in the U.S. will continue to be provided by general practitioners. To support these general practitioners, who often lack training in psychosocial interventions, it is essential that health care systems and payers embrace coordinated team-based care models. Team-based care—which typically involves a general practitioner, nurse and a mental health specialist working together to support the patient—not only generates better clinical outcomes for patients with co-occurring mental and physical health problems, it is also cost-effective for managing such complex health needs. Payers and health care systems need to invest in these types of structural and personnel solutions to complex patient care to genuinely embody the spirit of the Wellstone Act.”

Contact: [email protected]

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Kyle Grazier is the Richard Carl Jelinek Professor of Health Services Management and Policy at the School of Public Health and a professor of psychiatry at the Medical School. She is interested in improving access to behavioral health care services for vulnerable populations.

Grazier sees progress and reason for optimism in the new federal rules 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: [email protected]