Lack of behavioral health parity has extreme consequences for patients. The inability to find in-network care for these services requires patients without the means to pay for health care out of pocket to forgo care or make “really tough life decisions.”
“We’ve [heard] stories of members having to lose their homes because they have to choose to pay for a child to be able to be in residential care, and that is so expensive they can’t afford their rent or can’t afford their mortgage,” Sean Bell, general manager of new ventures at mental health provider Spring Health said at Behavioral Health Business’ INVEST event. “This is real.”
New York City-based Spring Health is a B2B virtual mental health provider that offers a variety of digital tools, including coaching, therapy and meditation. Spring has raised a total of $466.5 million, including a $100 million Series E round in July 2024. Its customers include Adobe, Bumble, Delta, Highmark Health and Guardian.
New parity laws are designed to alleviate these struggles by requiring payers to reimburse behavioral health services on par with physical health.
However, the providers who offer care and health plans paying for the bulk of in-network patients’ services may need to buckle up in anticipation of turbulence as these regulations shape the behavioral health industry.
Behavioral health parity
In September, the Biden administration released a final rule called The Mental Health Parity and Addiction Equity Act (MHPAEA), which updated how health plans can put limits on behavioral health benefits.
The rule promises benefits for patients as well as providers, and is a step “in the right direction,” according to Dr. Tamir Aldad, founder and CEO of Mindful Care.
“What’s huge here is being focused on the patients and their outcomes in terms of parity, no longer being able to limit the number of sessions someone can have the medications we could prescribe, co-pay and inpatient responsibility changes,” Aldad said. “All that is great when you focus on outcome-based care.”
West Hempstead, New York-based Mindful Care provides telehealth and in-person psychiatry, group and individual therapy. It prioritizes speedy, affordable access to treatment and promises same or next-day care. The provider most recently raised $900,000 in debt and other assets in July 2024, according to public documents. It previously raised $2.7 million in a Series A round and $7 million in a Series B round.
The issue lies in implementation and enforcement, Aldad said. Patients may have near-term improved outcomes, but it leaves question marks for providers. Payers’ abilities to maintain economic sustainability is unclear, he said, which may unbalance the alignment between providers and payers.
“When you look at it in a vacuum, it sounds excellent,” Aldad said. “As a clinician, certainly we support parity. It is in everyone’s best interest. But when you look at it holistically, we might be in for some turbulence when we try to see how sustainable it is across everyone involved.”
Behavioral health providers may now need to work with their health plans to ensure their behavioral health offerings match their other medical offerings, Bell said.
Parity across demographics
Aside from working with payers to ensure compliance with new regulations, providers can take active steps to promote parity by improving access across demographics.
Patients who do not get timely access to care can end up in emergency rooms or hospitals with costs of care 10 to 100 times higher than those who receive prompt treatment, Aldad said.
One key way providers can take action is to look beyond population-level care, including through measurement-based care.
“The ability to actually use assessments more frequently in having these touch points allows us to see individual trends rather than population trends,” Bell said. “It allows us to be a lot more thoughtful about targeting which groups and which people need care.”
Along with a measurement-based approach to care, Spring Health also tackles patient inequities by asking questions about social determinants of health. These questions include if patients experience food or housing insecurity or domestic violence and give a “very complete picture” of a patient’s biggest challenges, Bell said.
The most common barrier to care, according to Bell, is economic limitations. For some patients, the cost of co-pays and coinsurance can be insurmountable, most often for patients in need of substance use disorder (SUD) treatment. To prevent high costs of care, Spring determines when patients are at risk, rather than waiting for a condition to fully manifest.
“That allows us to shift the care down to different types of modalities where the overall cost is less expensive, which means the co-pay and the coinsurance is less expensive for them,” Bell said. “That’s making a big difference in people staying in care.”
In order for providers to take steps to reduce inequities, they must first be adequately incentivized, according to Aldad. The burden of improving access is often placed on providers, he said, but that can be unsustainable if clinicians are not “properly” incentivized.
The same parity laws that could cause some unease for providers could assuage the need for incentivization, however.
“The [MHPAEA requires] that plans demonstrate equitable payments across different types of care, so you can’t get away with charging or paying a provider,” Bell said. “At least in theory, we’re going to be in a scenario where, if traditionally, you would see behavioral health care providers getting paid substantially less for acute conditions as compared to an acute condition medically, that is going to be put up to pretty severe scrutiny over the next few months.”
