Behavioral healthcare currently exists in a unique historical moment. Healthcare costs continue to rise, and healthcare spending is growing faster than the average annual growth rate in the last decade.
Simultaneously, there is a growing demand for behavioral healthcare, making it the “bipartisan issue of our time” with broad bipartisan support in Congress.
Historically, affordability and behavioral health access issues have been viewed as conflicting. The rise in healthcare costs often led to restricted access to behavioral healthcare as a cost-cutting measure.
However, it’s crucial to recognize that affordability and access are intertwined rather than contradictory. By enhancing access to quality behavioral healthcare, affordability can be improved.
What challenges does this approach aim to tackle, and how did we come to believe the myth that affordability and increased access are mutually exclusive?
Affordability and access: the biggest challenges in BH
While rising healthcare costs are not a new issue, what presents a fresh challenge for health plans, employers, and individuals is the surging demand for access to behavioral health care, coinciding with historically high healthcare costs.
Notably, spending on behavioral health services among Americans with private insurance experienced a significant 53% increase from 2020 to 2022.
Affordability continues to get worse
Despite the growing need for quality behavioral healthcare, there’s a persistent need for improvements in both affordability and access. In the past year:
- 17% of insured adults didn’t receive necessary behavioral healthcare, with 44% citing affordability as the primary barrier
- The gap in out-of-network care utilization for behavioral health benefits compared to physical health benefits surged by 85%
- Insured individuals are over twice as likely to opt for out-of-network care and pay higher fees for behavioral healthcare compared to physical healthcare
Adding to the challenge, health insurance premiums for employer-sponsored plans increased by 7% in the last year, with expectations of further increases next year. This year, individuals, on average, paid $8,435 in premiums, while families faced a substantial $23,968 in premiums for employer-sponsored health insurance.
Ghost networks are rampant, driving barriers to access
Along with affordability challenges, individuals encounter difficulties reaching behavioral health providers or services, with ghost networks becoming prevalent.
A secret shopper study by a senate committee staff found that more than 80% of listed, in-network behavioral health providers are inaccessible. They either aren’t accepting new patients, are unreachable, or are not in-network as listed. Another study discovered that over half of all health providers listed on the Oregon Medicaid managed care providers’ network dodn’t see patients.
Almost half of Medicare Advantage online provider directories have at least one inaccuracy, often related to behavioral health services.
Access and affordability are deeply interrelated, especially for employers
During a recent Q3 earnings call, Cigna’s President and CEO David Cordani said, “In addition to affordability, one of the top priorities for many employers is expanding access, coordination, and overall effectiveness of behavioral health programs and solutions.”
Employees are demanding access to robust, high-quality behavioral health benefits from their employers—who are, in turn, demanding better behavioral health benefits from their health plan providers, while voicing concerns about cost.
This puts health plans in a tough spot. They aren’t in a position to stop healthcare inflation and can’t create new behavioral healthcare provider networks out of thin air.
The most impactful myth in behavioral healthcare
The current state of affordability and access has led to the biggest myth in behavioral healthcare—that there’s a choice between better access to behavioral healthcare and health insurance affordability.
The origins of this myth trace back four to five decades. Behavioral healthcare was initially treated as a cost center and largely ignored. Health plans were reluctant to provide coverage. Multiple rounds of congressional legislation addressing health parity laws ensued, compelling insurers to cover treatment, with pending parity regulation currently under consideration.
But what if the myth is wrong?
Many health plans have sought to reduce access to behavioral health services as a cost-cutting measure to enhance the affordability of health insurance.
But what if that reasoning is wrong? What if solving access and getting people into high-quality care improves costs for health plans and individuals?
Behavioral health is proven to drive medical spend. Suppose an individual has diabetes, cancer, or a heart condition. In that case, medical spend is two to three times higher for those individuals who also have a behavioral health condition than for individuals without.
A groundbreaking study by Milliman found that a small group of high-cost individuals are responsible for a significant percentage of total healthcare costs. These high-cost individuals were mostly people with behavioral health conditions, and yet many of these individuals had minimal or zero spending on behavioral health-specific services.
Stakeholders are starting to recognize that behavioral healthcare is not simply a driver of costs. It’s integral to people’s health and well-being. Neglecting it results in escalated healthcare costs. There is a path forward where medical spending is reduced, and people get better access to quality behavioral healthcare, mitigating two of the most significant issues in behavioral health.
Busting the myth
Shifting the narrative on this myth involves connecting the dots between better access and affordability, aligning business motives—such as growing revenue and market share for health plans—with the importance of better access to behavioral health for the growing population seeking these services.
Merely broadening access to behavioral healthcare doesn’t address affordability. The missing components are quality of care, including clinical outcomes, patient-provider matching, measurement-based care, and member experience.
Taking a broader perspective on the approach to behavioral healthcare in the last three decades reveals that implementing these fundamental building blocks—access, quality, member experience, and cost reduction—has largely fallen short. For many individuals, the behavioral healthcare experience has been far from satisfactory.
At MyCare, we think we’ve figured out how to balance these fundamental aspects of care. Let’s explore how we’re doing it.
MyCare’s approach
In behavioral health, bettering clinical outcomes starts with better access. If someone seeking care has to wait for a prolonged period to meet with a provider, they probably won’t engage in care in the first place. So, let’s start with access, and then we’ll cover the other pillars of this framework: quality of care, member experience, and cost savings.
Access
Elevated access to behavioral health providers goes beyond giving employees a list of providers. Individuals need the ability to make an appointment quickly with a provider who is accepting new patients, has a specialty that suits their needs, and has matching availability.
MyCare members have direct access to our entire provider network’s availability within our member platform, and can see all of a provider’s upcoming time slots, which are updated in real-time.
Our members are also getting:
- Fast access to care, with first therapy appointments available within 2 days
- Provider matching that utilizes data for precision healthcare
- Parity of experience and quality for members across the country
Quality of care
Another important pillar is hiring quality providers and ensuring they are helping people get better. During the recruitment and selection process, MyCare completes the following steps to ensure provider quality:
- Live interviews, instead of simply using a pass review of the applications
- Ensuring that the provider has at least three years of clinical experience
- Assessment of bedside manner, commitment to evidence-based practices and measurement-based care, and level of cultural responsiveness during the live interview
- Assessment of provider willingness to participate in a pay-for-performance system based on patient outcomes, not patient volume
The provider’s clinical outcomes are monitored and measured throughout the care process so we can know, using data, that they’re providing high-quality care.
Member experience
The MyCare app, where all our behavioral health scheduling and services are centralized into a single front door, has a rating of 4.9 stars out of 5 in the app store. Our providers have a 9.4 out of 10 rating from our member populations.
Here’s a snapshot of what it’s like to access a provider with MyCare:
- An employee or health plan member reaches out for help and accesses the MyCare member portal. It only takes a few minutes to set up their account and take a short online assessment.
- In a few minutes, they can book their first appointment with a therapist—who they’ve chosen from a diverse provider network—within two days.
- The members’ list of potential providers has been filtered using data from their assessment, inputted into powerful machine learning algorithms, to match them with the most suitable provider.
Cost savings
Connecting members quickly to high-quality care, using measurement-based care and precision health, leads to members getting measurably better, faster, and translates into cost savings through a reduction of overall medical spend.
The Validation Institute, an independent third-party organization, recently found that:
- For every $1.00 invested in MyCare, customers saved $2.20 on health plan spend. Savings increased to over $4 when accounting for reduced absenteeism and turnover.
- The largest savings were driven by a reduction in physical health spending, especially for people with chronic conditions, including $5,226 in savings for people with diabetes, $5,040 for people with hypertension, and $6,930 for patients with cancer.
- Overall, total health plan spend was lowered by $2,430 per participant within the first six months of engagement.
Letting go of the myth and charting a new path forward
The myth that it’s impossible to address behavioral healthcare affordability and access simultaneously has been destructive to both costs and human well-being.
People are hungry for better behavioral healthcare and rising healthcare costs, and it’s time for new ideas and pathways. This is a rare nexus where business motives and bettering human well-being come together.
