America's Benefit Specialist October 2023

EMPLOYER RESPONSE TO THE MENTAL HEALTH CRISIS

THE HEALTH AND WEALTH OF EMPLOYEES A 2021 survey, The State of Workplace Mental Health in the U.S., found that 76% of workers reported at least one symp tom of a mental health condition, with 80% of symptoms lasting up to a month and 36% lasting up to an entire year. Feelings of stress, anxiety and depression are compounded by the surging rate of inflation that impacts the “health and wealth” of health plan participants. Many employees are already financially fragile and strained by premium increases and unanticipated out-of-pocket expenses. In many cases, in part due to issues with network access or other times because of perceived stigma, employees are going out of network, and paying out of pocket, for their mental and be havioral care needs. McKinsey published insight on the affordability of mental health care and the long-term impact on financial health. The findings confirm that those who report mental illness disproportionately face economic disadvantages and greater financial stress. Surveys consistently show over two-thirds of American households live paycheck to paycheck. As a result, many believe they are unable to save in anticipation of medical expenses. Many are unprepared even for everyday expenses, let alone an unexpected medical bill, so affordabil ity barriers pose challenges for many in need of professional mental health services. A KFF survey confirms that approx imately half of the U.S. population goes without healthcare due to concerns over affordability, and one-quarter of those who receive care have financial hardship with paying their medical bills. EMPLOYER BENEFIT CHALLENGE Providing clients with the right balance between a benefit package that is both adequate and affordable yet financially sustainable has never been easy, but it is especially challeng ing given the current economic and social conditions. Nearly four out of 10 employers recently changed their benefits for mental health services, according to a survey conducted by KFF. The National Alliance of Healthcare Pur chaser Coalitions polled 221 employers that provide coverage to more than 10 million employees and their dependents. It found that just 31% are satisfied with network access for be havioral health care services. Only 34% of employers said that their behavioral health care directories accurately reflect the providers actually available. MENTAL HEALTH PARITY Limited provider networks are a prime issue for employ er-sponsored plans. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health plans that offer behavioral health coverage to ensure that financial require ments (such as deductibles, copayments, coinsurance and out-of-pocket limits) and treatment limits on these benefits are no more restrictive than those on medical and surgical

benefits. However, health plan benefits parity won’t address the identified crisis without an adequate number of providers. The Consolidated Appropriations Act of 2021 amended MH PAEA, in part by expressly requiring group health plans and health insurance issuers offering group or individual health insurance coverage that offer both medical/surgical bene fits and MH/SUD benefits and that impose non-quantitative treatment limitations (NQTLs) on MH/SUD benefits to perform and document their comparative analyses of the design and application of NQTLs. More recently, the Biden administration is specifically focused on ensuring NQTLs do not apply dispro portionately to mental health and behavioral services. Strengthening behavioral health parity protections is just one part of a larger policy discussion that includes address ing provider shortages, inadequate crisis infrastructure, and inadequate coordination and integration of primary care and mental health care. All of these issues contribute to the access and coverage challenges that mental health and behavioral health parity was supposed to address. Evaluating what an adequate network of mental health providers looks like, one that addresses the full spectrum of employee needs, will be key to developing enforceable standards of care. STRATEGIC AND HOLISTIC APPROACH Beyond changing benefits for mental health services, benefit professionals should take strategic action. Strategies in clude effectively designed acquisition-cost-based pharmacy pricing, HSA-capable coverage, reference-based pricing and adequate participant protections against balance-billing. Messaging to participants should focus more on building savings as part of a “health and wealth” strategy designed to optimize both savings and financial preparedness. There are also strategies that take advantage of price transparency, where participants become healthcare con PACKAGE THAT IS BOTH ADEQUATE AND AFFORDABLE YET FINANCIALLY SUSTAINABLE HAS NEVER BEEN EASY, BUT IT IS ESPECIALLY CHALLENGING GIVEN THE CURRENT ECONOMIC AND SOCIAL CONDITIONS. PROVIDING CLIENTS WITH THE RIGHT BALANCE BETWEEN A BENEFIT

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