Mental Health Marketplace Must Evolve To Meet Needs of Employers

BERKELEY, Calif. – October 16, 2018 –Mental health conditions such as depression, anxiety, and stress are growing in prevalence and cost – posing serious challenges for employers and other health care purchasers. To help these stakeholders understand how well today’s marketplace is meeting their needs when it comes to access, quality, and integration of mental health services with medical care, Catalyst for Payment Reform (CPR) released the State of the Mental Health Marketplace Report.

The Report summarizes findings and recommendations from the evaluation of 16 mental health service vendors including health plans, employee assistance programs, telehealth providers, navigation vendors, and digital solution providers, and includes supplemental research and expert interviews. The resulting State of the Mental Health Marketplace Report finds there are certain areas where today’s offerings fall short of meeting purchasers’ needs.

“For CPR to identify specific improvement opportunities in the mental health care marketplace, we needed to understand baseline access, quality, and integration capabilities,” said Suzanne Delbanco, PhD, executive director of CPR. “We applaud the 16 mental health service providers who volunteered to participate in the evaluation process for their commitment to transparency and accountability to the needs of their employer customer. There is more work to be done, but the release of this report is a first step.”

Earlier this year, CPR released specifications for purchasers to use in evaluating mental health services. CPR identified the evaluation criteria by working directly with employers and other health care purchasers, including 32BJ Health Fund, AT&T, Equity Healthcare, FedEx Corporation, King County (WA), SEIU 775 Benefits Group and the State of Minnesota.

Key report findings include:

• Employers want health plans and vendors to monitor the adequacy of their mental health provider network and the speed to care for patients. Employers want 98% of in-network providers to accept new patients, which CPR found to be achievable. However, it is essential to evaluate network adequacy and speed to care together; CPR found many respondents are not currently offering urgent care within a two- hour timeframe.
• Tele-mental health services are effective at providing private, convenient alternatives to in-person therapy. However, many telehealth vendors do not yet offer on-demand therapy or urgent care visits.
• There is a lack of standardization across the marketplace in the use of depression and anxiety screening tools or the measurement of clinical quality. Many respondents do not require the use of a specific standard clinical screening tools, leading to inconsistencies that make it difficult for employers to compare clinical effectiveness across providers or structure performance incentives. And few vendors report to customers on clinical quality measures assessing the treatment of more common mental health issues, instead of severe behavioral health conditions, on which at least health plans more commonly report.
• There is an increase in the number of digital programs available in the marketplace. Many digital services offer resiliency training or computerized cognitive behavioral therapy (cCBT) as a scalable form of support that can either supplement or replace traditional therapy.  Several companies demonstrate these programs can be clinically effective in treating anxiety and depression, but employers need to push for rigorous reporting on sustained patient engagement, a consistent challenge for digital solutions, to understand whether patients’ clinical improvements are maintained over time.  
• Clear opportunities exist to improve coordination between primary care and behavioral health care providers. Despite evidence that an integrated model can increase access to mental health services for members, few health plans measure the percentage of primary care providers who are co-located with behavioral health specialists. Health plans should also ensure that screening for depression and anxiety become a standard part of primary care office visits.

Click here to review the full State of the Mental Health Marketplace Report.

Mental health scorecards summarize performance

In addition to the public report, CPR developed scorecards to support its members in making educated purchasing decisions about mental health care services and evaluated how each of the 16 respondents performed against specific access, quality, and integration criteria.

“The ecosystem of mental health solutions is evolving rapidly,” said Michelle Harika, chief clinical officer, Equity Healthcare, a CPR purchaser member. “CPR’s comprehensive review of the solutions available directly empowers its members to discern which ones are rooted in clinical evidence and really advancing our options.” CPR will evaluate other categories of vendors, including producing scorecards for its members, as the need arises.

About Catalyst for Payment Reform

Catalyst for Payment Reform is an independent, non-profit organization working on behalf of large employers and other health care purchasers to catalyze employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. For a full list of CPR member organizations, click here.  For more information visit: www.catalyze.org and follow us on LinkedIn and Twitter.