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Editor's Note: Below is a brief excerpt from a complimentary Health Policy Unplugged note written by our Health Policy analyst Emily Evans. Click HERE to learn more about Emily's research process and the analysis subscribers receive. |
Not to depress you any more than a land war in Europe, a slowing economy and a volatile market has, but the future of mental health services in the U.S. is a focus of White House policy and of employer sponsored health plans like never before.
Because it has to be.
The pandemic of mental health after the pandemic of COVID is well underway and applying new pressure to a very fragile and ill-prepared mental health delivery system.
The latest data from the CDC on non-natural deaths (suicide, overdose, gun violence and physical abuse), indicate about 100k more people died during 2020-22 than the annual average of 2014-2019, an increase from about 500k to 600k.
The White House announced a new mental health policy last week that focuses resources on community-based services supported by technology solutions. There are reasons to be skeptical.
Federal strategies to address mental health conditions have been uniform failures. From mainstreaming in the 1960s, to mental health parity in the 90s, to the ACA's mandated services in the 2010s, nothing has moved the needle on coverage and reimbursement.
If you are going to say this time will be different, after a pandemic probably gives you a better than average chance of being right. It won't, however, be entirely due to federal efforts.
Employer-sponsored insurance and, to a lesser degree, Medicaid programs are leading the charge. We have heard on earnings calls for the last two to three quarters that behavioral health services are the most frequently requested from employers when expanding their scope of benefits.
We also know that employer-based insurance coverage of inpatient services is not rich, characterized by limited networks and low reimbursement. That being the case, it is hard to imagine they will suddenly open the wallet for 10-15 day inpatient stays.
Instead, during the pandemic, a myriad of solutions have emerged the most important of those being the proliferation of tele-behavioral health services and digital tools. Those directed at supporting the workforce are probably having the most impact, like Lyra.
DTC apps like TALK are going to have to consolidate but they are valuable in encouraging uptake of digital solutions, a necessary prerequisite for shifting the paradigm.
When Congress gets around to reviewing the Medicare telehealth waivers to determine what will be permanent and what goes away with COVID, behavioral services are almost certain to be included.
Research is still pending on the value of tele-behavioral health as a preventive but the American Telehealth Association is hoping to gather enough data to make a case for overall reduced costs to the system.
The federal government will have an role in developing the much needed workforce. The White House's plan calls for training for clinicians, paraprofessionals and peer specialists.
It also aims to make permanent the Certified Community Behavioral Health Clinics that were funded in the American Rescue Plan Act. It will take years but in the meantime employers will dig into their pockets to support their pricey workforce with the now destigmatized mental health services.
All this is to say, that the bull case for inpatient psych/SUD care depends on ignoring all these other trends (not to mention higher labor costs, weak efficacy and patient preference).
While there will certainly be a role for inpatient care, it will usually be played as a very last resort, not as the first and sometimes only line of treatment.
