This fall, the Biden administration issued new rules aimed at achieving parity between mental and physical health. The rule prohibits health plans from using more restrictive prior authorizations for mental health than for physical health and analyzes provider networks to ensure patients have access to mental health care. Requires planning.
Congress has passed measures toward mental health equity in the past, and while progress has been made in this area, there is still work to be done.
Marisa Domino is a health economist in ASU’s College of Health Solutions and executive director of the Center for Health Information Research. She spoke about this to The Show.
whole conversation
Marisa Domino: They will move in the right direction. I don’t think the problem will go away in terms of eliminating the disparity between mental health and medical surgical benefits. But I think this is a really complex area.
And I, you know, we’ve seen progress over the last 20 to 30 years, and I think this is still a move in the right direction.
Mark Brody: Why is it so complicated? For example, why is it so difficult for health insurance to cover mental and behavioral health in the same way it covers physical health?
Domino: One reason for this is that reporting is extremely complex. So when we think about insurance coverage, we might think about out-of-pocket costs. How much we have to pay each time we go to the doctor is set by our insurance company.
However, there are also what are called non-quantitative therapeutic limits. So behind the scenes, insurance companies may have other tools they can use to control the types and amounts of services we use.
One example is what is called pre-approval for certain types of benefits or services used. In reality, you can’t just go to the pharmacy and write a prescription. There may be a process in which your health care provider must obtain permission from your health insurance company for certain types of treatment before you know whether you can actually receive the treatment or service.
And they are more commonly used in the behavioral health field than in the medical-surgical field. So even though you might say that the out-of-pocket costs are the same, and the patient has to pay the same amount out-of-pocket. There may be efforts behind the scenes to control or limit the provision of services available to patients.
Brody: Is there anything the government can do to increase parity, like, is there anything the government can do to encourage this?
Domino: I think we can do even more. One of my mentors, Richard Frank, who works at the Brookings Institution, recently published a letter to the director of the Centers for Medicare and Medicaid Services, in which he wrote a letter to the director of the Centers for Medicare and Medicaid Services, saying that he would like to see more research done on outcomes, research on health care costs, and more. He suggested that there is also a possible method. When we compare the proportion of patients who use behavioral health services to the proportion of patients who use primary care, we cannot expect them to be equal, but we do find that some predictable proportion of those who require behavioral health services and continue to be monitored may exist. that.
Comparing this across populations and across health insurance plans could be a way to at least better understand who has access to services and who is limited by quantitative or non-quantitative treatment limits. There is.
Brody: Does this relate to the fact that when people have problems, like things that aren’t as obvious as broken arms or heart problems, their behavioral or mental health worsens in many ways? Or something like that. So are those elements still at work here?
Domino: Unfortunately, yes, I think that’s exactly the case. I don’t think there is a litmus test for mental illness. We rely on people to tell us about the symptoms they are experiencing and the burden of illness they feel from a range of symptoms.
And, you know, unlike diabetes where there are very specific tests that show whether a person has diabetes or not, and like there are x-rays that show whether you have a broken bone or not, we I don’t really have that level. The field of diagnosis in mental health. And, you know, I think there’s still a lot of stigma around mental illness and substance use disorders.
Brody: What conversations are happening in your world right now about what the new administration will do in this area in January?
Domino: Yes, that’s a great question. I think there are still concerns about restrictions on benefits.
I think a lot of progress has been made with the idea that we can improve a lot of health, not just through medical services, but through improvements in the social factors associated with health, or what we call the social determinants of health, such as food insecurity. , housing instability, these are areas where we’ve seen a lot of progress in health care planning, and the Medicaid program in particular can fund really innovative programs in that area that have ripple effects on health. .
And I think there are concerns that some of those efforts will be carried over by the current administration. So I think that’s one area of concern and just generous benefits.
I think there’s been a huge emphasis on private sector care, perhaps to the detriment of the public approach to providing health care. I think medicine can be extremely beneficial, especially in behavioral health.
There are complex mechanisms, so the price structure may not work as well as for consumption, such as apples, but it is very easy to do so through the private sector.
Brody: Do you think this is the kind of thing that each state can work on? If in some people’s minds the federal government isn’t doing enough, then this is something that the states like the Arizona authorities are doing here. Is it something we can try to implement or is it just not large enough?
Domino: No, absolutely. I think states are doing a lot of work individually in this area. One of the really great things about the Medicaid program is that there is a partnership between the states and the federal government.
So while the federal government creates a set of ground rules for all states to follow, each state has plenty of opportunities to innovate. So I think states could absolutely mandate new outcome monitoring when outsourcing care to private health plans or public health plans to ensure access.
We often talk about provider networks, or providers that accept certain types of insurance, and there is already a lot of work in this area that states need to do.
As you know, some states require health plans to have enough health care providers to meet the anticipated needs of their insured populations.
Brody: Is there any movement in this area of Arizona?
Domino: Oh, absolutely. I think Arizona’s Access to Medicaid program is a true game-changer in the behavioral health field. They created a new standard, a new way to integrate mental health and primary care so that people receive seamless care, whether they have medical-surgical needs or behavioral health needs. did. They set new standards to monitor. , to ensure that access is actually occurring on a meaningful basis.
So I think Arizona is an example in this area.
Brody: Okay, this is Marisa Domino. He is a health economist and executive director of the Center for Health Information Research in the ASU College of Health Solutions. Marisa, thank you so much for the conversation, I appreciate it.
Domino: Mark, it was a pleasure talking to you. thank you.
