Employer-Sponsored Health Plans Facilitated Mental Health Access

Nearly a quarter of individuals receiving coverage from employer-sponsored health plans accessed mental health support in 2020, according to research from AHIP.

Nearly 180 million Americans receive employer-sponsored health coverage. As the COVID-19 pandemic increased the demand for mental healthcare services, employer-sponsored health plans were there to help.

AHIP’s research reflects medical and pharmacy claims data related to mental health support from the IBM MarketScan Commercial Database between January 1, 2016, and December 31, 2020.

Twenty-three percent of members, or 41 million Americans, received mental health and substance use disorder treatment in 2020. Six million of these members were children who accessed mental health treatment through a parent or guardian’s employer-sponsored plan.

“Health insurance providers are committed to working together to improve access to mental health support for every covered patient who needs it. We will continue to work with community leaders and government officials to improve mental healthcare access,” Matt Eyles, president and chief executive officer of AHIP, said in the press release.

Out of the 41 million, 13 million members received individual and group psychotherapy, 22 million had behavioral health-related visits with a primary care physician (PCP), and 31 million received prescription drugs.

Psychiatrists, psychologists, licensed clinical social workers, or licensed therapists provide psychotherapy, but AHIP’s research showed how PCPs can play a significant role in accessing other mental health support.

Members had about three mental health-related visits per year with PCPs, the report noted.

More than half of patients who sought mental health services received it through a PCP, who can diagnose and treat certain mental health conditions like anxiety or depression. PCPs can also prescribe medications and refer patients to behavioral health specialists for more complex care.

“We need more innovative collaborations and solutions with mental health professionals and communities to address these complex issues,” Eyles said. “Health insurance providers are helping to make this happen.”

Individuals also had access to affordable prescriptions for mental health conditions through their employer-sponsored health plans. Members spent less than $15 in out-of-pocket costs for most generic prescriptions for ADHD, anxiety, bipolar disorder, depression, schizophrenia, and substance abuse.

Telehealth helped increase access to mental healthcare services during the pandemic. In 2020, nearly 40 percent of all psychotherapy visits occurred through telehealth, rising from less than one percent in 2019. Additionally, 30 percent of mental health-related PCP visits were conducted through telehealth, compared to less than one percent in 2019.

During the public health emergency, payers expanded telehealth coverage and implemented flexibilities to offer more coverage for virtual mental healthcare. Specifically, consumer-directed health plans (CDHPs) covered telehealth services pre-deductible for more than 32 million members who received coverage through their employers.

Congress authorized a temporary extension of this safe harbor in March 2022. AHIP encouraged federal leaders to make the policy permanent to ensure that individuals with employer-sponsored health coverage could maintain affordable access to mental healthcare.

AHIP also recommended that Congress consider taking steps to address the shortage of mental healthcare providers. In particular, providers in rural areas are facing high demand for mental healthcare services, but workforce shortages are hindering access to care.

AHIP’s data on mental healthcare utilization among employer-sponsored health plan members supports the results of a recent survey conducted by Morning Consult on behalf of AHIP.

The survey found that 29 percent of members with employer-sponsored health coverage sought after and received mental or behavioral healthcare services between 2020 and 2022. In addition, nearly nine out of ten respondents who accessed mental healthcare said they were satisfied with their services.

Members also noted that they had an easy time finding a mental healthcare specialist covered by their employer-sponsored health plan.