How Can Payers Better Support Adults with Behavioral and Mental Health Needs?

Mental health and behavioral health support is a critical need for health plan members. This is especially true for payers handling commercial, individual, and Medicaid populations with members.

As of 2024, the National Institutes of Health has found mental health conditions are common in 33.7% of adults aged 18 to 25 years, 28.1% of adults aged 26 to 49 years, and 15% of adults aged 50 years and older.

And according to the National Alliance on Mental Illness (NAMI):

  • 1 in 5 adults experience mental illness each year
  • 75% of all lifetime mental illnesses begin by age 24

Data collected from the NIH, Substance Abuse and Mental Health Services Administration (SAMSHA), and the Centers for Disease Control and Prevention (CDC) has also reported:

  • An estimated 33.5% of adults with a mental health condition illness also have a substance use disorder
  • Women are more likely than men to experience depression
  • Anxiety disorders are the most common form of mental health condition, with approximately 19.1% of U.S. adults having had an anxiety disorder in the last year
  • Depression is the second most common, with 21 million adults reporting at least one major episode

A Quick Look at Mental Health, Substance Abuse & Health Insurance

In 2020, KFF found that just over 37 million people with either a mental health condition or substance use disorder were covered by private insurance. The same year, the National Survey on Drug Use and Health found that 23.1% of U.S. adults experienced a mental health condition, and 32.9% experienced both a mental health condition and substance abuse disorder. That number has increased since.

KFF’s report on demographics and health insurance coverage for adults also found interesting connections regarding health insurance coverage and the distribution of mental illness and substance use disorders in adults:

  • Private insurance covers most adults with any mental illness (58%) and any substance use disorder (57%)
  • Medicaid covers 23% of those with any mental illness and 21% of those with any substance use disorder (About 13.9 million people)
  • An estimated 29% of Medicaid enrollees have a mental illness compared to 21% of privately insured and 20% of uninsured people
  • About 1 in 5 Medicaid beneficiaries have a substance use disorder, which is similar to individuals without insurance
  • Medicaid enrollees have the highest overall prevalence of moderate to severe mental illness or substance use disorders (39%) vs privately covered and uninsured individuals together (31% total)

See the image below from the KFF Report for a more visual representation. 

Clearly, mental and behavioral health support is needed by health care payers.

How Payers Can Improve Access to Mental and Behavioral Health Care

One of the greatest challenges with mental health support is enabling equitable access. There is an insufficient number of psychiatrists and psychologists available nationally right now.

Expand Access Via Primary Care Providers and Collaborative Care Models

Some are expanding access to mental health professionals and care networks by equipping primary care physicians (PCPs) to integrate mental and behavioral healthcare into their practice. This would put mental and behavioral care earlier within the care continuum, applying a more proactive, preventive approach And as a result, this could help reduce the risk of more complex and chronic illnesses and disorders.

Below are key highlights from research by AHIP on how health insurers are supporting primary care for this:

  1. 72% of health plans are training and supporting PCPs to care for patients with mild or moderate behavioral health conditions
  2. 72% are also assisting PCPS with finding specialists for referrals
  3. 56% of payers are offering telehealth or telephone consults with behavioral health specialists to PCPS

Broaden Value-Based Care Arrangements to Include Collaborative Mental Healthcare

As many payers continue to push value-based care models forward, some are also leveraging team-based mental healthcare approaches.

Following the Collaborative Care Model (CoCM) this offers the opportunity to leverage both care managers and PCPs.

Using an evidence-based model, this approach would allow payers to integrate care management, a patient-focused team, and measurement-guided care plans to include behavioral health and mental health.

Care managers could coordinate across multiple providers, align and integrate care delivery, and help better support individuals with chronic mental and behavioral health conditions. This type of approach can help payers get ahead of mental and behavioral health conditions. When a care management team can leverage a solution like HELIOS with behavioral and mental health-focused tools already integrated, they can focus on early diagnosis, risk assessment, employ timely interventions, continual outreach via integrated telehealth tools, and consistent follow-up care.

A Multi-Channel Approach to Better Mental Health

Another path toward closing the gaps in mental and behavioral health involves going beyond the more direct clinical settings.

CMS has recently experimented with community mental health workers utilizing a public health model of community health workers within a medical model. In an article by Fierce Healthcare, Eric Reinhart, MD, says community-based mental healthcare may be an opportunity for commercial health care payers to leverage.

The RTI Health Advance also notes a multi-channel approach by which health plans are partnering with pediatric care managers, school districts, and community-based organizations. NO reason this kind of model could not theoretically be applied to adults with employers, health plans, and community-based organizations collaborating.

Investing in and Incentivizing Mental and Behavioral Healthcare

The demand for behavioral health services is high, but as noted above, the supply of providers can’t keep up. This is driving higher costs recent data shows, which makes it even harder for health plan members to get the care they need. This is especially true for low-income individuals who are already struggling with routine healthcare costs along with today’s inflated costs of living.

One of the other ways payers are trying to improve mental and behavioral health support is by leveraging a care management platform like HELIOS that already fully supports behavioral health as a core capability.

HELIOS is a leading solution to coordinate integrated behavioral concerns in diverse populations as well as to manage highly specialized cohorts with both its core solution HELIOS, and its mobile application HELIOSgo.

The platform’s behavioral health module includes powerful tools for assessing and addressing behavioral and mental health needs.

Beyond direct care management and service provision, some payers are even directly funding and/or training mental and behavioral health care providers. RTI Health Advance noted two examples: (1) UCare funded $100,000 towards clinical intern stipends, and (2) Aetna partnered with Psych Hub to train more than 283,000 behavioral health providers, employee assistance program providers, internal clinicians, and CVS Health Minute Clinic counselors.

The U.S. Department of Health and Human Services is also complementing efforts like these with a roadmap for recruiting, training, and supporting a larger, more diverse behavioral health workforce.

There is a long way still to go, but around the country, efforts are being made to improve member’s access to and quality of mental and behavioral health care.

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