Shifting the Focus to Mental Health in Massachusetts

The Attorney General of Massachusetts wants healthcare services in the state to pay increased attention to mental health benefits, as highlighted in her Examination of Health Care Cost Trends and Cost Drivers report.

The new state Attorney General Maura Healy is shifting her focus from gaps in payment, which were highlighted in previous reports from the office, to mental healthcare, because "it’s really important to look at the whole health of the patient.” Healy believes that individuals with mental health and substance abuse problems need to be treated similar to a patient suffering from a chronic disease ike diabetes. Nearly 80% of those enrolled in the state plans, MassHealth or ConnectorCare, have distinct coverage for mental health and substance abuse, compared with 31% of commercial plan enrollees.

The primary objective of the report was to examine the intersection between administration of behavioral health benefits and reimbursement for behavioral health services with the goals of healthcare reform, so that individuals with behavioral health needs have improved access to coordinated and high-quality care at lower costs. The primary findings of the report were:

1. Exisiting approaches to managing behavioral health benefits and reimbursing providers for behavioral health services pose are a barrier for effective care coordination.

2. Behavioral health data lags compared to advances in data for other areas of health expenditures, challenging efforts to improve analysis and promote behavioral health parity.

The report recognized that while health plans distinguish between medical and behavioral benefits, for a patient suffering from mental health conditions, there is no such distinction. The report recommends several steps toward changing the current benefit structure to allow incorportation of behavioral health into mainstream medicine:

1. Payers and other stakeholders should consider addressing barriers to improving behavioral health reimbursement rates and the ability of all types of providers to invest in behavioral health services. 2. Stakeholders should consider developing meaningful financial incentives for providers and payers to integrate the delivery of medical and behavioral health services.

3. Providers and care management organizations should have increased access to information necessary to support timely and effective patient care.

4. Data on behavioral healthcare should at least mirror the scope of information available on price, utilization, quality, and spending for medical services.

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