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Comprehensive Mental Health Insurance Benefits:
Case Studies
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Office of Managed Care
I. Executive Summary
This report focuses on in-depth case studies of six employers, two health maintenance organizations (HMOs), and one managed behavioral healthcare organization (MBHO) in an effort to provide clear and well-documented examples for other companies and managed care organizations (MCOs) to consider. The report reveals several key themes about comprehensive mental health benefits.
Employers
- Study participants voluntarily provide comprehensive mental health benefits based on:
- a belief that employee mental health is crucial to the company's success;
- a recognition that mental health problems are common in the workforce, and that early intervention and continuing treatment can address such problems effectively;
- a "common sense" rationale that investing in the mental health needs of their employees will produce long-term savings by decreasing health care costs, increasing productivity, and reducing absenteeism; and
- an understanding that restricting mental health benefits may cause an increase in overall health care costs.
- All six employers invest significant resources in employee assistance programs (EAPs) that provide a wide range of services designed to increase access to care.
- One company offers mental health benefits at levels that exceed parity with physical health coverage. While none of the employers offers absolute parity between physical and mental health benefits, they do use alternative mechanisms to ensure comprehensive mental health care. Most companies exceed parity in some areas and fail to reach it in others.
- Employers recognize that unless employees access coverage, providing a comprehensive set of benefits is useless. In general, employers have developed cost-sharing structures that encourage employees to access mental health care, but also have placed more limits on extended use of outpatient psychiatric benefits than on physical health services of similar duration. They have implemented programs that fall outside the scope of traditional mental health services.
- Study participants offer comprehensive mental health benefits as part of a larger corporate culture that emphasizes investment in employees' overall wellness. Corporate leadership can help define this culture and can play a significant role in a company's decision to improve its mental health benefits.
- All six employers use different techniques and arrangements to manage mental health benefits; no specific formula defines the management approach to provision of comprehensive benefits. All employers take an active role in direct management of both the plans and the vendors. Rather than accepting the status quo, these companies evaluate their plan options continuously.
- The majority of employers did not use performance data to assess the effects of access to mental health care services on employee productivity and health care costs. Employers' decisions to provide comprehensive mental health benefits have been independent of such data. The employers rely heavily on employee feedback to shape benefit design.
Managed Care Organizations
- The HMOs and MBHO place high priority on integrating physical and mental health care services, as well as on maintaining open communication and coordination of care between mental health specialists and primary care physicians. All three organizations offer a wide range of services across the continuum of mental health care.
- The three MCOs, all of which are regional players, have felt the effects of recent trends toward consolidated and nationalized benefits. As more employers purchase benefits through national plans, regional vendors receive a decreasing share of private sector business. To remain competitive, they may need to alter their approach to providing regionally based products.
- Most of the performance data reported by the HMOs are Health Employer Data and Information Set (HEDIS) measures. All three MCOs use member surveys to measure satisfaction, quality of care, cost of care, and access to services. They also monitor behavioral-health-specific measures.
A literature review and a discussion with an Advisory Panel revealed significant problems inherent in developing a specific quantitative methodology to identify companies with "generous" benefits. Companies were selected after an examination of factors related to the priority they place on employee mental health care. Thus, the selection process identified employers that provide a range of innovative and flexible mental health benefits and that encourage employees to use them. The final group of six employers largely is the product of extensive self-selection; of the companies identified, these six showed significant interest.
The selection process for MCOs focused on specific managed care models. Staff model HMOs represented the majority of plans that offer benefits extending beyond a basic menu of services; however, many HMOs have moved away from staff models and toward provider networks. Consequently, this study examines two HMOs with experience integrating both models. Furthermore, since many MCOs carve out mental health services to a specialty firm, this study also includes one MBHO.
After study participants were selected, interviews were conducted with employer representatives; the results were synthesized into individual case studies. These case studies discuss the mental health benefit options, benefit management, performance data and monitoring, motivation for providing comprehensive benefits, and lessons learned/challenges remaining.
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