In a preliminary analysis, researchers found that federal parity regulations—which obligate health insurers to cover behavioral health services in a way that is on-par with medical services—had little immediate impact on improving access for patients in need of such services. Further, the researchers recommend greater enforcement of parity laws.
The federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was implemented in July 2010, with additional strengthening from the Affordable Care Act of 2010, which applied parity rules to more types of health insurance plans. Researchers studied utilization patterns of individuals with depression, bipolar and schizophrenia in the 12 months before MHPAEA implementation and the full year after its implementation.
According to Benjamin Miller, PsyD, University of Colorado School of Medicine, an author of the study, not only did the data show there was no increase in services used by the study population after the parity law, it also showed a significant decrease in the number of visits to psychiatrists and other mental health providers. Approximately 46,000 claims were examined.
“I was surprised—but not really,” Miller tells Behavioral Healthcare. “We would think that there would be some small uptick, but we know for a fact there are profound needs to address in mental health.”
Implications of the results
Miller notes the analysis follows the time period of the preliminary parity regulations. Final rules weren’t solidified until 2013. There are deeper issues around parity that data can’t capture, and information outlining state policy can be hard to find, he says.
Researchers identified seven states (plus Washington, D.C.) with weaker state parity laws, expecting to see more patients accessing more services in those states in light of the stronger federal laws, but that was not the case. The policy implication from the finding is that the federal law might not be having the effect that was intended.
“Parity righted a wrong around the inequity of mental health benefits and medical benefits,” Miller says. “But parity has done nothing to create a comprehensive benefit that allows patients to receive seamless access to behavioral health services.”
Providers battle insurers
Treatment providers continue to battle insurance carriers on behalf of patients on a number of access issues, including prior authorization of benefits for needed services. Miller says he understands their sentiment and believes that as a rule, patients are still jumping through too many hoops to get the behavioral healthcare they deserve.
The rigorous but limited study sheds some light on the need for large-scale transformations in the mental health delivery system, which has historically been neglected. Meanwhile, there is plenty of evidence that shows treating behavioral health issues often leads to improvements in medical issues, especially chronic conditions.
“Our payers and our providers are looking for what is ultimately going to be comprehensive change that provides a comprehensive benefit for patients,” he says. “And we’re not seeing that yet. There are examples and pockets of brilliance, but that’s not seen at a benefit-design level.”
Later this year, the parity analysis will be expanded to include utilization patterns from 2009 through 2013.
“We are confident that there are additional stories to tell—this is one of many,” Miller says. “It’s also important to recognize that insurance design and benefits do not always impact downstream clinical transformation.”
The study followed patients with depession, bipolar or schizophrenia and measured the number of visits in a 12-month period to psychiatrists, psychologists and other mental health providers, comparing the "pre" and "post" MHPAEA utilization.