With new essential health benefit rules, some insurers are starting to take a more proactive approach to mental and behavioral health.
Advocates have long complained of access and parity standards for treatment under many health plans, although in recent years more insurers have tried to improve their drug benefits and coverage offerings for mental illnesses and offer community-based and online support programs for those suffering addiction, depression and stress.
While the Affordable Care Act's essential health benefits require coverage for mental and behavioral health services, there are a variety of proactive approaches insurers can take, from public outreach to more advanced clinical designs, according case studies from the Alliance of Community Health Plans.
In greater Minneapolis, the cooperative insurer HealthPartners is joining other organizations like the Mayo Clinic in co-sponsoring the "Make It OK," a campaign aimed at reducing stigma across the spectrum -- anxiety, attention deficit and hyperactivity, bipolar, depression, eating disorders, obsessive compulsivity, post-traumatic stress and schizophrenia.
The campaign's message, delivered through print, TV, digital media and events with local businesses and community groups, is that people should "ask for help when they need it and understand that their illness is not shameful."
Has the campaign been successful? In some small part, HealthPartners and other organizations may be preventing downstream problems by reaching people with lingering, unaddressed issues. That's not been investigated, but as measured by engagement, the campaign partners say they are seeing early successes, with more than 100,000 individuals visiting the website, watching documentaries or coming to live events.
In Portland, Oregon, the Medicaid and Medicare health plan Care Oregon has created a "Health Resilience Program," to designed especially for individuals with multiple chronic conditions and mental, social or addiction challenges -- some of the most vulnerable and expensive public beneficiaries in the country.
After one year, according to the Alliance of Community Health Plans, inpatient hospital admissions for individuals in the program declined by 30 percent and emergency room visits in half.
Using claims data to find the best candidates for intervention, CareOregon dispatches a healthcare worker with a experience in behavioral health to meet with patients, craft individualized plans and help them navigate challenges like housing.
The key to CareOregon's program has been its emphasis on "non-traditional" support services and interactions, like outside of a hospital or clinic, which can be high-stress places in their own right, according to ACHP. This can mean a representative helps them move out an apartment where alcohol, tobacco and drug use are prevalent, meeting in a park or cafe, and using motivational conversation to encourage healthy behaviors and self-esteem. Prior to the program, these individuals averaged 3.1 hospital inpatient admissions and 13.1 ED visits per year. After one year, they averaged only one admission and 5.8 ED visits.
Another approach to high-risk member engagement has been deployed by UPMC Health Plan, the insurance subsidiary of the University of Pittsburgh Medical Center. Called Connected Care, UPMC and its behavioral health management company Community Care use a multi-disciplinary team to identify high-needs patients, offer them a medical home primary care program and tailor individualized plans that emphasize self-management. Since 2009, the target population has seen a gradual but significant reduction in emergency room use and 30-day readmissions, according to the ACHP.