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Behavioral Healthcare Parity Is Low Among Regional, State Plans

Behavioral Healthcare Parity Is Low Among Regional, State Plans

Although the coronavirus pandemic has imposed significant changes on the healthcare industry particularly in regards to behavioral and mental healthcare, historically behavioral healthcare parity has not been a priority for payers and, as a result, compliance, network adequacy, and use of value-based payments are all low, according to an Avalere survey.

The survey covered 37 decision-makers in healthcare organizations that included payers, behavioral health management organizations, and integrated delivery networks.

“Behavioral health did not emerge as a top management priority or area of organizational expenditure, indicating opportunity for greater attention,” the researchers noted. “However, the impact of the COVID-19 PHE on plan member mental health needs and utilization may increase attention and management effort in upcoming plan years.”

Payers evaded certain requirements such as assessing behavioral healthcare network adequacy. Legally, payers have to conduct an assessment that covers various adequacy indicators from wait times to out-of-network utilization. Eight out of ten survey participants had conducted an analysis of their network adequacy. 

Among regional or state health plans and behavioral health benefit management organizations, the rates of compliance on this issue were especially low. Nearly four in ten regional or state health plans reported that they did not conduct the assessment (38 percent).

In contrast, 100 percent of integrated health systems complied as did 94 percent of national health plans.

More than half of all survey participants (54 percent) reported that they had estimated a significant amount of out-of-network care utilization in behavioral healthcare. Regional and state health plans were most likely (62 percent) to cite significant out-of-network behavioral healthcare utilization, followed by national health plans (59 percent).

“Surveyed plans recognized the need to expand behavioral health provider networks and indicated ongoing efforts to recruit additional providers. However, a national shortage of behavioral healthcare providers may be limiting network expansion efforts,” the survey acknowledged.

Read more about behavioral healthcare parity here. 


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