Drug Abuse

Inexpensive remedy for psychological sickness and substance abuse will get tougher to seek out – The Washington Publish


A report published by Milliman, a risk management and healthcare consulting firm, found that the likelihood of patients accessing outsourcing is dramatically increasing , by network operators for the treatment of mental health and drug abuse than for other diseases. The differences have been increasing since Milliman published a similarly grim study two years ago.

The latest study examined the claims data of 37 million people with commercial preferred provider organization health plans in all 50 states from 2013 to 2017.

● People who were hospitalized due to behavioral health problems became pregnant in 2017 with a 5.2-fold probability to a provider outside the network referred than for medical or surgical treatments.

● In drug abuse treatment, the numbers were even worse: at inpatient facilities, treatment was 10 times more likely to be out of the network – compared to 4.7 times in 2013.

● 2017 One child left the network 10 times more often for a visit to the health department than for a visit to the primary care.

● Spending on all types of drug abuse treatment accounted for only 0.9 percent of total health care costs. Psychiatric treatment accounted for 2.4 percent of total spending in 2017.

In 2017, 70,237 Americans died of drug overdoses and 47,173 died of suicide, according to Centers for Disease Control and Prevention. By 2018, nearly 20 percent of adults – more than 47 million people – had a mental illness, according to the National Alliance on Mental Illness.

"I thought we might have made some progress here. It is very depressing to see that it has actually gotten worse, "said Henry Harbin, former CEO of Magellan Health, a managed behavioral medicine company and adviser to the Bowman Family Foundation, which commissioned the report. "Employers and insurance companies have to quadruple their efforts."

The networks of insurance plans are simply inadequate, Harbin said, which is not surprising as insurance companies consistently reimburse behavioral health care providers at lower rates. For example, the study found that the rate of primary care visits was 23.8 percent higher on average than the rate of visits to behavioral medicine.

If a plan had a shortage of oncologists or cardiologists, he said an insurance company would pay more to get additional providers into the network. "It can be done pretty quickly," he said. "Just raise interest rates in areas where you do not have adequate primary care, such as in the medical field."

Tom Insel, psychiatrist serving as Chief Adviser to California Governor Gavin Newsom (D) on Mental Health In California, the report found that in-patient behavioral health care is not networkable at 7.8 times the probability.

If you have Medi-Cal, you actually have better access to care than commercial insurance. This is unthinkable under medical conditions, "said Insel, who led the National Institute of Mental Health from 2002 to 2015." We would never allow this for heart disease or cancer. "

Cathryn Donaldson, a spokesperson for America's Health Insurance Plans, the industry's most important trade group, said insurers are working diligently to ensure that they comply with federal parity law. However, the national shortage of mental health providers and the many clinicians who do not want to subscribe to insurance networks are driving more patients out of the care supply network.

"Health insurance providers routinely assess the adequacy of their provider networks so that patients have timely access to behavioral health care while using recognized metrics to track and improve patient outcomes," Donaldson wrote in an email ,

Michael Thompson, President and Milliman's report confirms what he has heard from employers.

"This is a situation they can not handle anymore," he said. "When their people try to get appointments with network psychiatrists, they can not even get a call back."

When employers select a plan for workers, they usually consider whether the network is appropriate, Thompson said. Often, however, they are "phantom networks" of providers who no longer accept the insurance or do not accept new patients. "What happens if you effectively buy a damaged product?" He said.

Patients and their families often suffer the consequences.

In 2017, Terresa Humphries-Wadsworth took her 14-year-old son to an emergency room in Cody, Wyo. Because he expressed suicidal thoughts. The staff sent him to a psychiatric ward in the nearest hospital. It was 100 miles away in Montana. Her son spent 10 days there before Humphries-Wadsworth learned the hospital was out of the network. The closest network facility was 200 miles from their home.

The family had to pay $ 110,000 out of pocket for two inpatient visits and in-patient treatment. They negotiated the amount with the hospital and a collection agency and then took out loans to pay him back, she said.

Earlier, when her son had diabetes, it was not a question of whether the insurer would pay for his treatment, said psychologist Humphries-Wadsworth. "How is his mental health – which was life-threatening – not covered in the same way as his need for diabetes and acute care? Why are not they treated the same? "

Former Congressman Patrick J. Kennedy (DR.I.), who promoted federal parity law and now runs the Kennedy Forum, which focuses on law enforcement, said the solution is clear: "The moment that [insurers] the same payments are made for brain disease as for all other illnesses, the sooner we get to the people who have access to the treatment they need."

Following the publication of the Milliman Report, the Kennedy Forum and several other mental health organizations have sent a letter to the Chairman of the Energy Committee, Rep. Frank Pallone Jr. (DN.J.), and Rep. Robert C. "Bobby" Scott (D-Va.), Chairman of the Education Committee, calls for congressional hearings on parity.

Meiram Bendat, a mental health lawyer who has filed multiple parity lawsuits, said enforcement by the states and federal government is much more stringent needed to ensure that patients receive the access they are gu aranteed under the law.

"Without substantial fines against insurers, nothing will change because there is no incentive to change," he said.

Kaiser Health News is a non-profit news service that deals with health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.