7 Ways That Payers Help Members Manage Their Mental Health Needs

Helping members find the right providers

Finding a mental healthcare provider or a primary care provider who is aware of mental health and behavioral health conditions is challenging for members. Three-quarters of members who have sought out mental healthcare services hold health insurers responsible for their access—or lack thereof—to mental healthcare providers. 

Some health insurance companies have offered recommendations about how to find mental health providers that will meet members’ needs.

Sharp Health Plan advised members regarding the various types of mental health providers. 

The health plan encouraged members to consider the differences between therapists, counselors, psychiatrists, and psychologists as they seek mental healthcare services and to assess which might be best suited to their needs. The payer also recommended that members write down questions about the issues that they wish to discuss with potential providers and bring these to their appointments.

For members who are looking for culturally competent mental health providers, AmeriHealth Caritas posted five questions that members can ask in order to assess a provider’s cultural competency. 

The payer’s questions invite members to consider whether the provider takes an interest in the member’s social context, asks about any stigmas or social determinants of health that might have produced barriers to care in the past, acknowledges differences in backgrounds where they exist and checks in on the member’s concerns and expectations about those differences, and more.

Members are not always aware that they need help or the severity of their own mental health conditions. 

To connect at-risk members with the right type of care, CareOregon implemented an artifical intelligence software from Clarigent Health. The tool helps identify behavioral healthcare patients who are becoming suicidal by looking for patterns in speech.

Creating opportunities for care through telehealth, online platforms

In addition to connecting members with providers, health insurers have also empowered members to advocate for and find solutions for themselves, offering opportunities for members to find the kind of care that best suits their needs through telehealth and digital platforms.

Payers like The Health Care Service Corporation (HCSC) and Blue Cross and Blue Shield of Montana (BCBSMT) sought to empower members by giving them access to a mental healthcare platform from Learn to Live. 

The platform allows members to connect with cognitive behavioral therapy and mental health assessments at any time of the day or night. More specifically, it is designed for members who have mild to moderate depression, anxiety including social anxiety, substance abuse, and other mental healthcare needs.

Highmark health plan offered members access to a 12-week evidence-based program called Meru Health. The program is designed to serve members with depression, anxiety, and burnout. It integrates personal therapy consultations and peer support groups with technology-based mindfulness practices, video lessons, and more. 

All of the program’s services are available by phone. After members complete the course, they still have access to mental healthcare support through Highmark.

Horizon Blue Cross and Blue Shield of New Jersey offered members access to a mental health coaching program called MindRight Health that conducts its services via texting. The program targets individuals between the ages of 13 and 25 who need emotional support and coaching. Coaches on the platform are overseen by mental healthcare providers.

Designing new payment models

Payers are testing innovative alternative payment models to help boost patient outcomes for mental and behavioral healthcare.

Recognizing care disparities in mental healthcare, CareOregon partnered with the Alliance for Culturally Specific Behavioral Health Providers to create a payment model that leverages an enhanced fee schedule and health-related services dollars through Medicaid to reward culturally specific provider services. 

The health plan projected that this payment model would boost payments to culturally specific providers by as much as 20 percent as well as a ten percent payment boost for bilingual and bicultural service delivery.

Point32—the corporate entity for the combined Tufts Health Plan and Harvard Pilgrim Health Care—partnered with an outpatient addiction, mental health provider to offer substance abuse care to members with comorbidities through a value-based program. The payer connects members with prescribers, psychiatric and mental health care, therapy, peer support, and more, with a strong emphasis on population health management.

Expanding, educating the mental healthcare workforce

One of the key barriers to care that payers have to face is the size of the mental healthcare workforce. While workforce shortages are not a recent phenomenon in the healthcare industry, the mental healthcare sector has been particularly strained in recent years. 

Policymakers and experts alike have acknowledged the overwhelming demand for mental and behavioral healthcare needs and the ongoing provider shortage. These shortages result in burnout for healthcare professionals in mental healthcare and exacerbate care disparities for members in disadvantaged communities.

Some payers are addressing the mental healthcare workforce shortage by providing more opportunities in academia. 

UCare partnered with mental health providers to fund clinical intern stipends so that finances can be less of a barrier to individuals seeking to join the mental healthcare workforce. The payer put $100,000 toward a pilot program that financially supports students as they undergo training and licensing for social work, clinical counseling, and other forms of mental healthcare.

Specifically, the pilot program offers support to clinical interns who come from a range of underrepresented populations.

Another way that health insurers address shortages in the mental healthcare workforce is by training individuals in other areas of healthcare to identify and respond to mental healthcare needs in their patients.

For example, Aetna partnered with Psych Hub to train 283,000 behavioral healthcare providers, employee assistance program providers, Aetna internal clinicians, and CVS Health Minute Clinic counselors on suicide prevention and intervention for young adults and adolescents.

Expanding the mental healthcare workforce is crucial. However, when health plans have narrow networks of mental healthcare specialists, they compound the negative impacts of the workforce shortage and further limit members’ access to care. 

Private health plan members have indicated that their health plans’ mental healthcare options are less satisfactory when compared to their clinical health networks.

Health insurance companies like Blue Cross and Blue Shield of North Carolina and CareFirst BlueCross BlueShield are seeking to rectify this by expanding members’ access to in-network behavioral healthcare providers. Through these payers’ partnerships with Headway, plan members can access in-network therapists and psychiatrists within 48 hours.

Regence Health Plans took the traditional route of expanding its in-network services by hiring more providers. The payer brought on a new senior medical director of behavioral health and expanded its behavioral healthcare network by over 1,000 behavioral healthcare providers.

Offering population-based services

In addition to strategies that are designed to provide broader access to mental healthcare services, payers have implemented targeted strategies that are tailored to the needs of specific member populations.

Anthem Blue Cross and Blue Shield instituted a mental healthcare solution that was designed specifically for college students who are struggling with anxiety and depression. The payer partnered with Christie Campus Health, a mental healthcare service company in Massachusetts, to offer a mental health platform to students through the payer’s Student Advantage health plans.

Another Anthem solution targeted member populations that have complex conditions. The High Outreach to Promote Engagement (HOPE) program established case managers for members who have multiple chronic conditions and who are at higher risk for hospitalizations and emergency room visits due to mental health or substance use disorder incidents or physical complications.

HOPE case managers can support members with tasks such as setting up doctor’s appointments, but they can also address social determinants of health needs like connecting members with transportation. The goal is to anticipate members’ needs. The program has halved major health incidents in this population, Anthem reported.

Magellan Health has created a program that serves the mental health and wellbeing needs of military families. The program fuses Magellan Health’s clinical support and resources with a third-party, phone-based tool called Neuroflow. The tool offers self-directed mental health resources to military service members and their spouses.

Supporting caregivers

While much of the healthcare industry’s attention is rightly directed toward mental healthcare patients, caregivers also bear a significant burden and require support. Caregivers, specifically women, often neglect their own mental healthcare needs in order to serve the individuals that rely on them.

CareSource partnered with the Montgomery County Board of Developmental Disabilities to support caregivers of individuals with intellectual and developmental disabilities and behavioral healthcare challenges. The partners offered respite services to families whose children with disabilities, including after-school and day programming.

Navigating the healthcare system can be especially taxing for parents whose children have complex mental health needs and disabilities. 

To serve these populations, Medica launched two support programs: the Family Support Program and the Family Support Navigator. The first program supports families with children who have complex mental health needs through clinical support and care navigation. The second program uses an online program to connect families with resources for children with autism or depression.

Expanding research, awareness

Outside of providing direct support to members, health insurers can also help create a culture of mental healthcare support that de-stigmatizes mental health by spreading awareness and expanding research.

Beacon Health, Centene, Cigna, and other payers have published research or have announced plans to publish research about the mental health crisis and potential responses to it. Their efforts address the mental health epidemic’s impact on various member populations, including adolescents, seniors, and communities of color.

Payers like Blue Shield of California have participated in the BlueSky initiative, which trains educators to identify mental health needs among students as part of its mission to support mental healthcare among youths. 

Centene and other payers have conducted employee training programs to create an internal culture that de-stigmatizes mental health conditions and substance use disorders.

While there is no silver bullet to end the mental healthcare crisis in America, health insurance companies are pursuing a number of avenues to address barriers to progress, the AHIP resource demonstrated.