Pandemic Presents Opportunity for Payers to Renew Focus on Behavioral Health

A new report from the Washington, D.C.-based health care consulting firm Avalere Health is highlighting payers’ shortcomings in behavioral health.

Specifically, researchers found that payers still have work to do when it comes to ensuring parity compliance, improving network adequacy, adopting value-based models and focusing on other factors that could boost behavioral health access. The good news, however, is that the coronavirus could help catalyze some of those changes, according to the report.

“While survey results indicate that payers have not typically prioritized management and expenditures around behavioral health at the highest level, the [public health emergency’s] exacerbation of the existing mental health crisis has helped to reinforce the importance of these services,” Avalere researchers wrote. “Payers are beginning to take steps to increase access to care through improving network and reimbursement adequacy, implementing collaborative care, and increasing access to and use of telehealth services.”


Parity, network adequacy

For the report, Avalere surveyed payers, integrated delivery networks and behavioral health management organizations, with 37 decision-makers at risk-bearing entities included. Participants were asked about parity, provider reimbursement, value-based payments and more.

Among other key takeaways, the report found that many payers aren’t complying with parity or conducting analyses to compare behavioral and medical benefit adequacy — though both are required by law.

In fact, only half of all behavioral health benefit management organizations surveyed reported analyzing provider network adequacy for behavioral health.


On top of that, more than half of all respondents reported that inadequate networks were prompting a considerable number of their members to seek out-of-network services, which typically come with more out-of-pocket care costs for beneficiaries.

Regional and state health plans were the worst offenders, with respondents in that group estimating an out-of-network care utilization of 62%.

Additionally, the report looked at trends in behavioral health reimbursement, a long-time pain point for providers in the space. Low payment rates are often blamed for behavioral health access issues, as they make it harder to recruit and retain clinicians. That, in turn, contributes to access shortages and inadequate behavioral health networks.

The good news for providers is, though, that 75% of respondents said they plan to raise reimbursement rates by at least 6% in the near-term to help with those issues.

Higher reimbursement isn’t the only potential solution that has been posed to address some of behavioral health’s most common access issues. Alternative payment structures have been suggested, too.

Many behavioral health stakeholders are bullish on value-based payment models’ potential to improve behavioral health access. However, only 33% of survey respondents said they’re currently using value-based payment for behavioral health. Still, of those not participating in value-based models, ​​58% expressed interest in doing so.

Amid the backdrop of the COVID-19 emergency, which has caused more than half of all Americans to struggle with their mental health, Avalere’s findings highlight the opportunity — and need — for payers to make behavioral health a greater area of focus going forward.

“New mental health parity legislation … will reinforce increased access to behavioral healthcare as payers undertake efforts to ensure compliance,” the authors of the report wrote. “Interest and expected implementation of value-based coverage for behavioral health services may present opportunities for innovative engagement on behalf of behavioral health stakeholders and may ultimately result in beneficiary access to a broader set of services and therapies.”

You can find Avalere’s full report here.

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