4 minute read

Whole person care means that people have access to both physical and behavioral healthcare. Unfortunately, there is no parity for such treatments by payers here in the United States. Payers intentionally limit their coverage of behavioral healthcare. But now the Biden administration wants to see that change.

Yesterday, the Biden administration proposed new rules that would require payers to study beneficiary outcomes to ensure both physical and behavioral healthcare benefits are administered equally, taking into account provider network and reimbursement rates and whether prior authorization is required for care. In effect, payers would be forced to show their cards or make modifications to comply with the law. If they do not modify, then payers give the Department of Health and Human Services clear cause to enforce parity law.

Mental health parity law has existed in the US since 2008, but the federal government has failed to enforce the law consistently. Stigma, expensive treatment costs, and lack of effectiveness studies are likely contributors. Often, payers will only cover acute and crisis mental health needs, while ignoring effective treatment of underlying conditions. This lack of parity continues even as demand for behavioral healthcare is higher than ever.

The philosophy of integrated care is to give patients access to timely, effective, whole-person care by a team of health professionals working together. The failure of the federal government to enforce parity laws has allowed payers to limit coverage and slow the dissemination of integrated care. Healthcare organizations are more likely to adopt integrated care when it is financially sustainable.

I’m glad to see the White House take action on parity. If the Biden staff read this post, then I hope they will consider a few additional rules:

1. Evaluate integrated care outcomes: Require payers to evaluate clinical and financial outcomes of beneficiaries who receive integrated care services. We do not know enough about the benefits of integrated care compared to traditional, siloed care. This information could help payers justify reimbursement for integrated care services.
2. Increase provider adoption of integrated care: Require payers to make it easier for providers to adopt integrated care models. This can be done by notifying providers of resources available for training, consultation, and practice transformation. Many providers have no idea where to begin with integration, especially in rural and underserved areas.
3. Increase beneficiary awareness of mental health: Require payers to make it easier for people to understand the value of mental health treatment and to find it, including integrated mental health services. Many people are not aware of the importance of mental health care or the availability of mental health treatments. Increasing public awareness about these issues could help to reduce the stigma associated with mental health conditions and could encourage people to seek help.

The current healthcare system is not perfect. Payers and policymakers can work together to make a better system that benefits everyone, especially the most vulnerable individuals with unmet mental health needs. The proposed Biden rules will be available for public comment before final versions are made. In the meantime, we will be watching how it all turns out.