5 Key Policy Issues for Employers and Mental Health

This week, the American Psychiatric Association (APA) released results of a public opinion survey on several key mental health issues, including how well employees can access mental health care at work. The American Journal of Managed Care® asked Darcy Gruttadaro, JD, director of the APA Foundation Center for Workplace Mental Health, responded to several questions about employees’ ability to accessing benefits through their insurance coverage, and what employers can do to reduce stigma surrounding mental health care.

Gruttadaro said the APAF Center has covered many of these issues in a series of 5 policy recommendations for employers who want to improve access to mental health and substance abuse care. They are:

1. How Can Employers Ensure Network Adequacy?

The Center spells out specific steps for employers, through their health plans or behavioral health organizations, to create an action plan—or a correction action plan, if they decide their current networks do not have enough access. Employers can start by expanding services at the inpatient and outpatient levels, and engaging regional and national organizations to add providers, including specialty providers. They can update provider directories to ensure accuracy and make sure employees can easily find out which ones are accepting new patients. Reimbursement must be adequate; providers should have financial incentives meet access and quality metrics. The Center’s website features specific billing codes that health plans can use to check whether psychiatrists are participating in the plan.

2. How Can Employers Ensure Mental Health Compliance?

Gruttadaro said it was “extremely concerning,” but not surprising, that 27% of the APA poll participants said their employers do not offer adequate mental health coverage. But often, she said, the health plan that contracts with the employer is not following the Parity Act. So, what can an employer do? Asking the right questions matters. Employers or employer coalitions must check whether denial of care rates for mental health and substance abuse care are comparable to those for medical services—and if not, ask why not, as well as create a plan for this to be corrected. Ask about differences in the frequency of in-network and out-of-network care for mental health compared with medical services. Employers should conduct their own independent assessment by a qualified expert, because this can get them ahead of examinations by state insurance commissioners.

3. How Can Employers Advance Measurement-Based Care?

Employers and coalitions should ask their health plans for action plans that require providers to use standardized measurement tools, such as the Patient Health Questionnaire (PHQ-9) or the Generalized Anxiety Disorder 7-item scale (GAD-7) and requires them to provide aggregated outcomes data for employees being treated for both mental health and substance abuse conditions. Employers need proof that workers are being screened for depression, anxiety, substance abuse, suicide risk, and serious mental illness. They should ask if their health plans offer incentives and reduce administrative burdens for providers who take part in network quality improvement programs and require standardized screenings such as PHQ-9 and GAD-7.

4. How Can Employers Promote the Collaborative Care Model?

The Collaborative Care Model (CoCM) promotes the full integration of behavioral health care within the primary care practice, so that providers can discuss a holistic approach to patient care—and allow patients to receive treatment for all needs in a single location. Is the employer using health plan that is promoting the CoCM across primary care practices, including through the use of its CoCM Current Procedural Terminology billing codes? If employers are unsure what the CoCM involves, they can learn more from APA’s training model. Employers who are familiar with the CoCM can ask their health plans to provide training for providers, including how to use billing codes.

5. How Can Employers Promote the Expansion of Telepsychiatry?

Telemedicine can reduce missed medical appointments and missed time at work, so it’s a win-win. For psychiatric care, it can offer patients increased privacy and access to specialists who might be located far from their home or office. Educating both area providers and employees is essential. Employer coalitions should make training available for in-network providers on the mechanics of delivering care this way. Employers and employer coalitions can require that health plans offer telehealth at the same rate as in-person care.

Besides these policy recommendations, Gruttadaro said APA has tools for employers seeking to reduce stigma about seeking mental health care. The new survey showed that young men were especially unlikely to seek assistance. APA makes available Right Direction, a customizable depression awareness initiative used by more than 2000 employers to address stigma, as well as a series of case studies that can be searched by keyword, industry, and number of employees.