The document discusses several issues with the current state of mental healthcare in the United States. Mental health services faced major funding cuts in 2008, resulting in fewer treatment options. This has exacerbated problems of inadequate and inaccessible care, especially for low-income individuals. Approximately 18% of U.S. adults have a mental illness, yet there is a shortage of psychiatrists due to numerous barriers. Integrating physical and mental healthcare could help address high rates of co-occurring conditions and improve outcomes, but the fragmented system continues to leave many without proper coverage or treatment.
Integrating Behavioral Health into Primary Care – Thought Leaders in Populati...Epstein Becker Green
Although mental health and substance abuse (behavioral health) services have historically been segregated from traditional medical care, its impact on patients’ well-being, physical health and cost-of-care has become increasingly critical to improving clinical quality outcomes while significantly decreasing financial costs by tens of billions of dollars. Drs. Daviss and Coleman will discuss the advances in policy and practice regarding the integration of behavioral health with physical health, as well as some of the gaps in identifying, aggregating, and analyzing data critical to a more holistic and comprehensive view of the individual.
In addition, the speakers will:
* Identify the clinical, legal, social, and financial impacts of behavioral health disorders on chronic medical conditions.
* Describe the challenges involved in improving clinical and financial outcomes in patients with chronic medical conditions who also have behavioral health symptoms and/or conditions.
* Demonstrate the rewards for implementing new information technology applications and analysis for better clinical and financial outcomes for these specific populations.
Moderator
* Mark E. Lutes, Member of the Firm and Chair of Epstein Becker Green's Board of Directors
Speakers
* Charles A. Coleman, PhD, Senior Sponsor of IBM's Population Health Insights and Programs Management of IBM's Healthcare Solutions Board
* Steven R. Daviss, MD, DFAPA, Chief Medical Officer at M3 Information, LLC, a DC-based mobile mental health information technology company that developed the peer-reviewed multi-dimensional, patient-centered mental health screening tool, M3Clinician
Epstein Becker Green Webinar - Moderated by Mark E. Lutes - http://www.ebglaw.com/events/the-challenges-and-rewards-of-integrating-behavioral-health-into-primary-care-%E2%80%93-thought-leaders-in-population-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The three pillars of healthcare reform are to increase patient safety, improve healthcare quality,
and bend the cost curve. Integration of behavioral health services in the primary care setting can
substantially contribute to all three objectives. Yet despite efforts to recruit behavioral health specialists to rural America the number of mental health profession shortage areas in the U.S. has increased 97% during the past decade. This webinar will provide actionable information that practitioners and Health Center executives can rely on to evaluate and implement telebehavioral health services successfully and thereby realize their substantial value.
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Population health management real time state-of-health analysispscisolutions
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
Integrating Behavioral Health into Primary Care – Thought Leaders in Populati...Epstein Becker Green
Although mental health and substance abuse (behavioral health) services have historically been segregated from traditional medical care, its impact on patients’ well-being, physical health and cost-of-care has become increasingly critical to improving clinical quality outcomes while significantly decreasing financial costs by tens of billions of dollars. Drs. Daviss and Coleman will discuss the advances in policy and practice regarding the integration of behavioral health with physical health, as well as some of the gaps in identifying, aggregating, and analyzing data critical to a more holistic and comprehensive view of the individual.
In addition, the speakers will:
* Identify the clinical, legal, social, and financial impacts of behavioral health disorders on chronic medical conditions.
* Describe the challenges involved in improving clinical and financial outcomes in patients with chronic medical conditions who also have behavioral health symptoms and/or conditions.
* Demonstrate the rewards for implementing new information technology applications and analysis for better clinical and financial outcomes for these specific populations.
Moderator
* Mark E. Lutes, Member of the Firm and Chair of Epstein Becker Green's Board of Directors
Speakers
* Charles A. Coleman, PhD, Senior Sponsor of IBM's Population Health Insights and Programs Management of IBM's Healthcare Solutions Board
* Steven R. Daviss, MD, DFAPA, Chief Medical Officer at M3 Information, LLC, a DC-based mobile mental health information technology company that developed the peer-reviewed multi-dimensional, patient-centered mental health screening tool, M3Clinician
Epstein Becker Green Webinar - Moderated by Mark E. Lutes - http://www.ebglaw.com/events/the-challenges-and-rewards-of-integrating-behavioral-health-into-primary-care-%E2%80%93-thought-leaders-in-population-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The three pillars of healthcare reform are to increase patient safety, improve healthcare quality,
and bend the cost curve. Integration of behavioral health services in the primary care setting can
substantially contribute to all three objectives. Yet despite efforts to recruit behavioral health specialists to rural America the number of mental health profession shortage areas in the U.S. has increased 97% during the past decade. This webinar will provide actionable information that practitioners and Health Center executives can rely on to evaluate and implement telebehavioral health services successfully and thereby realize their substantial value.
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Population health management real time state-of-health analysispscisolutions
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
Effect of State Regulations on Health Insurance PremiumseHealth , Inc.
Overall, these results provide solid evidence that the state-level regulations of health insurance are correlated with higher premiums. The regression model estimates that the presence of health plan liability laws increases monthly premiums by $21.84. Laws that give subscribers direct access to specialists increase monthly premiums by $31.15. Provider due process laws increase premiums by
$16.62. Finally, each additional mandated benefit increases premiums by $0.75. All of these findings achieve statistical significance.
This presentation offers critical insights on thinking and acting on health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
Understanding the vocabulary of health insurance helps in selecting and using coverage effectively. eHealthInsurance commissioned a national study to determine public awareness of select health insurance terminology and the specifics of health insurance coverage. Americans admit to a health insurance vocabulary deficit.
Only a fourth (23%) feel they are very sure of what the terminology used in their health insurance policy actually means.
A third are somewhat sure of what the terminology actually means (32%).
One-fourth are not very sure (13%) or have no idea (10%) what the terminology used in their health insurance policy means.
One-fifth report they don’t have health insurance (21%).
The public demonstrates its lack of familiarity with health insurance terminology by not knowing what some of the key abbreviations stand for.
Only one-third of Americans (36%) can volunteer that HMO stands for health maintenance organization.
Only one-fifth (20%) recall that PPO stands for Preferred Provider Organization.
Only one out of nine (11%) recalls that HSA stands for Health Savings Account.
When asked how sure they were with some of the specifics of their health insurance policy, most people said they were very sure of the amount of their co-payment (61%), but half or fewer were very sure they knew the amounts of other basic elements of their coverage:
Half said they were very sure of what they paid for their health insurance premiums (50%).
45% were very sure of their annual deductible.
41% were very sure of the level of their plan’s co-insurance.
35% were very sure of their maximum annual out-of-pocket costs.
For each of these items, one-fifth indicated that the questions were not relevant since they did not have health insurance (21%).
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
These slides are from on lecture on the role of psychotropic drugs in mental health treatment. Topics covered include the pharmaceutical industry, direct-to-consumer advertising, the CATIE and STAR*D studies, Medicare Part-D, and the role or pharmacy benefit managers.
From the Customer Experience Trend tracker this presentation is the one used for the webinar addresed by Qaalfa Dibeehi, Kalina Janevska and Colin Shaw: A well
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
Addressing health equity & the risk in providing careEvan Osborne
What Is Health Equity & Why Should It Be Addressed?
How Does Health Equity Impact Providers & Payors?
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
How Can Health Equity Be Addressed Through Technology?
Get ready to be surprised in this fast paced, top 10 focused session! Based upon the latest Speak Up Project findings from over 415,000 K-12 students, including 34,000 students from California, you will learn how students really want to use mobile devices, social media and digital content to enhance learning - key data you need to inform budgets, programs, policies and instruction.
Effect of State Regulations on Health Insurance PremiumseHealth , Inc.
Overall, these results provide solid evidence that the state-level regulations of health insurance are correlated with higher premiums. The regression model estimates that the presence of health plan liability laws increases monthly premiums by $21.84. Laws that give subscribers direct access to specialists increase monthly premiums by $31.15. Provider due process laws increase premiums by
$16.62. Finally, each additional mandated benefit increases premiums by $0.75. All of these findings achieve statistical significance.
This presentation offers critical insights on thinking and acting on health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
Understanding the vocabulary of health insurance helps in selecting and using coverage effectively. eHealthInsurance commissioned a national study to determine public awareness of select health insurance terminology and the specifics of health insurance coverage. Americans admit to a health insurance vocabulary deficit.
Only a fourth (23%) feel they are very sure of what the terminology used in their health insurance policy actually means.
A third are somewhat sure of what the terminology actually means (32%).
One-fourth are not very sure (13%) or have no idea (10%) what the terminology used in their health insurance policy means.
One-fifth report they don’t have health insurance (21%).
The public demonstrates its lack of familiarity with health insurance terminology by not knowing what some of the key abbreviations stand for.
Only one-third of Americans (36%) can volunteer that HMO stands for health maintenance organization.
Only one-fifth (20%) recall that PPO stands for Preferred Provider Organization.
Only one out of nine (11%) recalls that HSA stands for Health Savings Account.
When asked how sure they were with some of the specifics of their health insurance policy, most people said they were very sure of the amount of their co-payment (61%), but half or fewer were very sure they knew the amounts of other basic elements of their coverage:
Half said they were very sure of what they paid for their health insurance premiums (50%).
45% were very sure of their annual deductible.
41% were very sure of the level of their plan’s co-insurance.
35% were very sure of their maximum annual out-of-pocket costs.
For each of these items, one-fifth indicated that the questions were not relevant since they did not have health insurance (21%).
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
These slides are from on lecture on the role of psychotropic drugs in mental health treatment. Topics covered include the pharmaceutical industry, direct-to-consumer advertising, the CATIE and STAR*D studies, Medicare Part-D, and the role or pharmacy benefit managers.
From the Customer Experience Trend tracker this presentation is the one used for the webinar addresed by Qaalfa Dibeehi, Kalina Janevska and Colin Shaw: A well
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
Addressing health equity & the risk in providing careEvan Osborne
What Is Health Equity & Why Should It Be Addressed?
How Does Health Equity Impact Providers & Payors?
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
How Can Health Equity Be Addressed Through Technology?
Get ready to be surprised in this fast paced, top 10 focused session! Based upon the latest Speak Up Project findings from over 415,000 K-12 students, including 34,000 students from California, you will learn how students really want to use mobile devices, social media and digital content to enhance learning - key data you need to inform budgets, programs, policies and instruction.
Pink of Blue? Examining gender sensitivity in games - SXSWedu 2016Julie Evans
Contrary to what we may want to believe, emerging research indicates that use of digital tools and content within learning is not gender-blind. While girls and boys share a common interest in technology to support personalized learning, their uses of and aspirations for digital learning are often quite different. This is especially true with game-based learning. In this workshop, we will roll up our sleeves and interact with a variety of games that are popular in education. Using a new evaluation tool, participants will gain an insider perspective on gender-bias or sensitivity within games by examining the characterization, imagery and language, storyline and results of the game play.
Experience Fair Presentation in the Learning Route: Practical solutions to adapt to climate change in the production and post-harvesting sectors: the cases of Mozambique and Rwanda.6th – 16th of November 2016
Climate Change and Adaptation (CCA) strategies: Experiences from Uganda
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Ch. 5 Paying for Health CareLearning ObjectivesAfter reading.docxcravennichole326
Ch. 5 Paying for Health Care
Learning Objectives
After reading this chapter, you should be able to:
Distinguish the benefits and shortcomings of private sources of payment for the care of vulnerable persons.
Identify the benefits and shortcomings of public sources of payment for the care of vulnerable persons.
Recognize the most common public payer options, and understand their eligibility requirements.
Understand how health care is financed for people with no health insurance coverage.
Introduction
Photo of a large group of people protesting in front of a white government building. A woman at the front left of the photo carries a sign that says, "Responsible capitalism, healthcare for all." A man at the front right of the photo holds a sign that says, "Medical bankruptcy has a face."
Courtesy of Jodi Jacobson/iStockphoto
Costly new technologies and the free-market nature of the health care industry have raised the cost of health care.
The cost of health care is rising, in part because of expensive new technologies and procedures, and in part because of the market failure of the health care industry. It has been argued that deregulation of health insurers, combined with a free market health care industry, has changed health care from a service-based structure to a commodity, or a product available for purchase. America's health care delivery system is geared toward the multibillion dollar health insurance industry rather than individual payers, many of whom lack the financial ability to cover health care expenses out of pocket, from general emergency room care to a life-threatening illness. After all, few people have $10,000 in their budgets to cover the cost of an emergency room visit for a broken arm.
Americans purchase health insurance to cover medical bills, but health insurance is too expensive for many families to afford. In 2010, 64% of the American population had private health insurance for all or part of the year. That isn't a very large majority, considering that everybody needs medical attention at some point. In that same year, 31% of the population had government-run public health insurance, and 16.3% had no health insurance at all for all or part of the year (DeNavas-Walt, Proctor, & Smith, 2011). The question across America, from Congress to kitchen tables, is how to insure all, how to tackle rising health care costs, and how to decipher a fair and equitable payee process.
Critical Thinking
What do you think will be the impact if health care costs are not addressed? What future problems do you predict?
5.1 Private Payers
The private payer sector comprises programs that provide financial access to health care, which includes insurance companies, employer-run health coverage programs, and individuals who pay for health care out of pocket. Individuals who pay for all of their health care out of pocket are rare, as the cost of health care is prohibitive. Employer-run health coverage programs are types of i ...
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
Why Emplyers care about Pimary care 2008Paul Grundy
Employers are beginning to recognize that investing in the primary care foundation of the health care system may help address their problems of rising healthcare costs and uneven quality. Primary care faces a crisis as a growing number of U.S. medical graduates are avoiding primary care careers because of relatively low reimbursement and an unsatisfying work life. Yet a strong primary care sector has been associated with reduced health care costs and improved quality. Through the and other efforts, some large employers are engaged in initiatives tostrengthen primary care. [Health Affairs 27, no. 1 (2008): 151–158;
U.S. Behavioral Health Market Size to Hit Around US$ 132.4 Bn by 2027MichaelCrichton7
The U.S. Behavioral Health Market was valued at US$ 90.5 billion in 2020 and is projected to be worth around US$ 132.4 billion by 2027, registering a CAGR of 5.3% from 2021 to 2027.
Developing non-clinical approaches and are pathways to fundamental socioeconomic issues that are presented in the primary care and secondary care settings
Re-Imagining Psychiatric Care - Presentation (1).pptx
Final_Policy_Brief_1
1.
Shrink:
Effects
of
the
Declining
Number
of
Psychiatrists
BACKGROUND
Mental Health services (MHS) took a devastating
$4.3 billion cut during the 2008 recession, resulting
in fewer hospital beds for mentally ill (MI) patients,
decreased incentive to practice psychiatry, decline
in current practicing psychiatrists driving up costs
of MHS. 1
Evidence based medicine suggests the
most effective treatment combines frequent,
regular (sometimes lengthy), talk therapy sessions
and expensive medications, often hindering
insurance company profits.2
Cuts and profit driven
insurance reinforce flawed aspects of our mental
health system, perpetuating a cycle of
inaccessible, inadequate treatment options. Those
in a low socioeconomic position (SEP) experience
greater barriers given the number of psychiatrists
refusing to accept Medicaid, Medicare and private
insurance.3
A high prevalence of MI, mostly among
low SEP citizens, demonstrates the demand for
reform, while providing an opportunity to make
substantial positive change in a range of fields
beyond mental health.4, 5
BURDEN OF DISEASE
Prevalence
18.1% of all U.S. adults suffer from MI excluding
substance abuse disorders such as alcoholism6
,
and suicide remains within the top 10 causes of
death across age groups, and the 2nd most
common cause of death among 15 – 34 year olds.7
Disparities and Comorbidity
Co-occurring physical and mental health
conditions affect 34 million adults – roughly 17% of
the nation – as they are risk factors for each other.5
Physical illness can add to distress, triggering
more severe MI episodes and vice versa.
Individuals with comorbid conditions experience
higher rates of hospital readmission and higher
health care costs. This impedes positive health
outcomes for both disorders. patients with
comorbid conditions typically lack strong social
support and the ability to independently follow
prescribed treatment. Age of death is younger than
the national average, yet from the same leading
causes of death as the general population (heart
disease and cancer).5
Fragmented treatment can
lead to conflicting recommendations and
confusion among patients.
Increased rates of MI are found in minority groups
and families with low SEP along with higher rates
of cancer and heart disease (often in younger age
bracket). Overlap in prevalence suggests low SEP
is a distal cause of comorbid physical and mental
conditions, highlighting gaps in the current system
while providing a defined population for
intervention.4
2. Economic Burden
Productivity decline costs the United States $21.7
billion annually, due to 217 million days of work
lost or partially lost by individuals with MI.
Furthermore, MI patients with behavioral disorders
typically fall in SEP, putting them at risk of
comorbidity, homelessness and incarceration. “In
2005, Medicaid and state and local governments
accounted for 61% of behavioral health care
expenditures, compared with 46% for all health
services”. 5,8
Why aren’t there more Psychiatrists?
Medical students are unlikely to choose Psychiatry
as a specialty despite demand.
• Residency training for psychiatry is roughly 3
years longer than the average residency
training (excluding special surgery) raising
student loan debt.
• Insurance companies have rigid restrictions,
lowering reimbursement.
• Social stigma in medical school. Psychiatry is
not considered a “real” science.
Accepting insurance leads to lower annual
income. Fees and percentage of reimbursement
incentivize shorter sessions which forces
psychiatrists to shift from talk therapy to drug
therapy. Caps on appointments through the
year often result in monthly appointments as
opposed to weekly, further incentivizing
psychiatrists to focus on volume of patients as
opposed to quality. Yet, insurance companies
require “prior authorization” for new patients of
a board certified, private practice psychiatrist,
limiting the patient from receiving critical care
and the psychiatrist to increase volume.9
Many
psychiatrists refuse to accept insurance allowing
freedom to set fees and transfer burden of risk and
cost to the patient.
Social demands of supporting MI patients can
cause severe emotional distress among
professionals, and when it comes to a psychotic
break, suicidality or emotional distress, we are no
better at prediction than a coin toss.10
This
reinforces the belief that psychiatry is a soft
science.
Hospital Cuts
Hospitals and in-patient, government funded
clinics are meant to serve as a safety net for
Medicare and Medicaid patients who cannot pay
cash for services or medication. MI patients in
need of extended, in hospital treatment drain
resources and revenue. Budget cuts during the
recession forced hospitals to prioritize profit
generating treatments, services and volume over
quality.11
Limitations of Current Parity
The Mental Health Parity and Addiction Equity Act
(MHPAEA) of 2008 expands coverage by elevating
MHS to the standards of physical health care.
Insurance companies that provided mental health
coverage cannot place greater restrictions for MHS
than they would physical health services. However,
insurance companies are not required to offer
MHS coverage.
3. The Affordable Care Act aims to close the gap by
requiring insurance plans competing in the Health
Insurance Marketplace to offer MHS coverage in
order to be considered a Qualified Health Plan.
Private health plans and employer based plans are
required to comply with the 2008 parity. Increasing
coverage among low SEP adults and children will
be provided by CHIP, Medicaid managed care and
Medicaid Alternative Benefit plans.
Providing equal coverage for plans that currently
cover MHS leaves Medicare, traditional fee-for-
service Medicaid enrollees and “grandfathered”
small employer plan subscribers without coverage.
Given the proportion of high risk populations
utilizing these services it is clear that the most at-
risk are still unable to access care.
Expansion of MHPAEA does little to incentivize
medical students to choose psychiatry and does
not require private practice psychiatrists to take
insurance or Medicaid or Medicare patients.
Hospitals are forced to accept the influx of patients
despite limited budgets and declining availability of
psychiatric beds. MHS are still fragmented and
leave gaps for high risk populations.12
Policy Recommendations
The CDC recommends a public health approach to
MI through integrated care. Understanding the
mechanisms behind comorbidity and increasing
preventative programs can decrease the number of
people currently falling through the MHS coverage
gap.12
Increasing communication between
physicians and psychiatrists, especially in hospital
settings, decrease costs and confusion for MI
patients. Hospital and psychiatrist revenues
increase due to lower rates of readmission and
decreased dependency on frequent, lengthy talk
therapy sessions. Models for a successful
integrated care program can be found at the Mayo
Clinic in Rochester, MN, the Veteran’s Affairs MHS
study, and St. Anthony Hospital in Oklahoma City,
OK.5
References
1. State Mental Health Legislation 2015: Trends, Themes and
Effective Practices (Issue brief). (2015, December). Retrieved
February 15, 2016, from National Alliance on Mental Illness
website: 1. https://www.nami.org/About-NAMI/Publications-
Reports/Public-Policy-Reports/State-Mental-Health-Legislation-
2015/NAMI-StateMentalHealthLegislation2015.pdf
2. Harris, G. (2011). Talk Doesn’t Pay, So Psychiatry Turns Instead
to Drug Therapy. Retrieved February 19, 2016, from
http://www.nytimes.com/2011/03/06/health/policy/06doctors.html
?pagewanted=all
3. Miller, D., MD. (2014, January 25). Why psychiatrists don’t take
insurance [Web log post]. Retrieved February 15, 2016, from
http://www.kevinmd.com/blog/2014/01/psychiatrists-
insurance.html
4. Centers for Disease Control and Prevention. Public Health
Action Plan to Integrate Mental Health Promotion and Mental
Illness Prevention with Chronic Disease Prevention, 2011–2015.
Atlanta: U.S. Department of Health and Human Services; 2011.
5. Trend Watch. Bringing Behavioral Health into the Care
Continuum: Opportunities to Improve Quality, Costs and
Outcomes (Issue brief). (2012, January). Retrieved February
15, 2016, from American Hospital Association website:
http://www.aha.org/research/reports/tw/12jan-tw-
behavhealth.pdf
6. Any Mental Illness (AMI) Among U.S. Adults. (n.d.).
Retrieved February 19, 2016, from
http://www.nimh.nih.gov/health/statistics/prevalence/any-
mental-illness-ami-among-us-adults.shtml
7. [10 Leading Causes of Death by Age Group, 2013]. (2013).
Unpublished raw data.
Data Source: National Vital Statistics System, National Center for
Health Statistics, CDC Produced by the National Center for Injury
Prevention and Control, CDC, using WISQARS
8. Kessler, R., Herringa, S., Lakoma, M., Petukhova, M.,
Rupp, A., Schoenbaum, M., . . . Zaslavsky, A. (2008, May 7).
Retrieved February 15, 2016, from
http://www.ncbi.nlm.nih.gov/pubmed/18463104
9. Boyd, J. (2014, November 13). Why is it so hard to see a
psychiatrist? Retrieved February 19, 2016, from
http://theconversation.com/why-is-it-so-hard-to-see-a-
psychiatrist-34131
10. Hamilton, J. (2015, April 1). No Easy, Reliable Way To
Screen For Suicide. Retrieved February 19, 2016, from
http://www.npr.org/sections/health-
4. shots/2015/03/31/396399647/no-easy-reliable-way-to-screen-for-
suicide-specialists-say
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