America's Benefit Specialist October 2023

EMPLOYER RESPONSE TO THE MENTAL HEALTH CRISIS

sumers with control over economic purchasing power and decision making. HEALTH SAVINGS ACCOUNTS HSAs can play a vital role in building savings for covering out-of-pocket medical costs in current and future years. With its unique tax advantages and ease of use, the HSA is a great companion to mental health support services as providers and medications that treat mental health conditions and substance abuse are HSA-qualified medical expenses. REFERENCE-BASED PRICING As noted earlier, seldom is the network of mental health providers adequate. And even where the network is ade quate, some/many network providers are not accepting new patients. Forced to access treatment from out-of-network providers will increase participant out-of-pocket expenses. Those increased costs typically include two components: (1) separate and higher deductibles and lower coinsurance, and (2) no control over provider fees—sometimes resulting in excessive charges and balance-billing. In some plans, the majority of mental health and sub stance abuse providers are out-of-network, making refer ence-based pricing an appropriate strategy. A “pure” RBP design eliminates the dependency on a network’s ability to negotiate a price for a specific provider in a specific location for specific services. Since there are neither in- or out-of network providers, there is no requirement to determine a median in-network rate or contracted rates, so pure RBP de sign avoids the cost of direct contracting and network access fees. Since in-network charges also tend to vary substantially from provider to provider, pure RBP also ensures the refer ence price applies in every situation. Pure RBP, done right, also includes participant represen tation to manage any balance-billing claims. It will, over time, also lower the cost of coverage, in turn lowering both employee and employer contributions. ALTERNATIVE PROGRAMS An employee assistance program is a voluntary, work-based program that generally offers free and confidential assess ments, short-term counseling, referrals and follow-up ser vices to employees who have personal and/or work-related problems. The EAP is an employee benefit that is separate from health insurance and is typically paid for by the em ployer without any participant copays, deductibles or other cost sharing. Health and wellness Initiatives are programs designed to improve and promote health and fitness. Many firms offer such programs directly to workers and their household members; however, some health plans incorporate their own wellness programs for all enrollees.

VALUE OF A MEDICAL BILLING PARTNER Benefit professionals, plan sponsors and third-party admin istrators are benefiting from partnerships with tech-en abled medical billing-support services that provide valuable cost-management insights through data-driven solutions. Real-time price information of provider services enable plan participates to make the most advantageous cost-benefit decisions regarding their care options. 1 www.gallup.com/workplace/404174/economic-cost-poor-em ployee-mental-health.aspx 2 www.who.int/news-room/fact-sheets/detail/men tal-health-at-work#:~:text=Globally%2C%20an%20estimated%20 12%20billion,per%20year%20in%20lost%20productivity. 3 www.whitehouse.gov/briefing-room/statements-releas es/2022/03/01/fact-sheet-president-biden-to-announce-strategy to-address-our-national-mental-health-crisis-as-part-of-unity agenda-in-his-first-state-of-the-union/ 4 www.hhs.gov/about/news/2022/10/20/us-surgeon-general-releas es-new-framework-mental-health-well-being-workplace.html 5 www.whitehouse.gov/cea/written-materials/2022/05/31/reducing the-economic-burden-of-unmet-mental-health-needs/ 6 www.usnews.com/news/best-states/articles/2021-06-10/north eastern-states-have-fewest-mental-health-provider-shortages 7 www.nami.org/support-education/publications-reports/pub lic-policy-reports/the-doctor-is-out 8 www.mindsharepartners.org/mentalhealthatworkreport-2021 9 www.mckinsey.com/industries/healthcare/our-insights/how-af fordable-is-mental-healthcare-the-long-term-impact-on-finan cial-health 10 www.prnewswire.com/news-releases/number-of-americans-liv ing-paycheck-to-paycheck-has-increased-301624801.html 11 www.kff.org/health-costs/issue-brief/americans-challenges-with health-care-costs/ 12 https://files.kff.org/attachment/Report-Employer-Health-Bene fits-2021-Annual-Survey.pdf 13 www.nationalalliancehealth.org/news/voice-purchaser-survey/ 14 www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/ resource-center/faqs/aca-part-45.pdf 15 www.kff.org/other/state-indicator/men tal-health-care-health-professional-shortage-areas-hpsas/?cur rentTimeframe=0&sortModel=%7B%22colId%22:%- 22Location%22,%22sort%22:%22asc%22%7D 16 https://aequumhealth.com/blog/how-to-make-reference-based pricing-work-for-your-plan/

Christine Cooper is the CEO of aequum LLC and the co-managing member of Koehler Fitzgerald LLC, a law firm with a national practice. Founded in 2020, aequum serves third-party administrators, medical cost-management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide, defending medical

balance-bills and delivering savings to employer-sponsored health plans. Christine is an avid runner and Ironman and is active in a variety of community affairs.

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