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1/ Good article by two leaders in the #mentalhealth space by @DrWennberg & @ZekeEmanuel. These two inspire me. But we can't just hope payers increase rates. We can improve access with a new care option: mental health coaches .... https://cnn.it/3aCuYbl
2/ We’ve known for a while mental health payer reimbursements are low. Even if mental health providers were paid on par with PCPs when delivering care (currently, they get 24% less), there is still a big gap between payer reimbursement and cash pay. For a 45 min therapy session
3/ in NYC (CPT code 90834), a therapist gets reimbursed, on average, $80. (high end) This same therapist can get $150-250 for that same session with cash pay. They also don’t have to deal with billing. Payers aren’t going to increase reimbursements to that level anytime soon.
4/ Yes, mental healthcare reduces member costs for payers. But it takes time for a member to recover or learn to manage their condition. By the time they do, it could be 1+ years and since the churn rate can be high at payers, the payer may not see these cost-savings. So as a..
5/ payer, why invest your $ in mental health reimbursement, when you can in a diabetes prevention program where you can see a return in < 1 year? I don’t think we can plan on payers increasing reimbursement to compete with cash pay anytime soon. However, I do have a solution.
6/ Mental health coaches. Mental health exists on a spectrum. For patients on the lower end of the spectrum, coaching can provide a lot of value. These coaches draw from evidence-based techniques to deliver care (e.g., CBT). I’m not saying coaches replace licensed providers.
7/ But we can add them to the supply to improve access. Also, coaches are paid a lower rate than therapists. So payers will be able to improve access and not have to increase reimbursement rates. (they could even save $ with coaches) But is it a priority?
8/ The sickest mental health patients cost the most. So that’s where the biggest opportunity to save $ is. Payers focus here. There isn’t a big opportunity to save $ with members that would benefit from seeing a coach. (some argue therapists too) So what’s the incentive ...
9/ for a payer to provide coaching? Improve access? Not much. We have all been conditioned to accept that mental healthcare is hard to get. We’ve given up in a way. I think the best way to move past this and get access to care that we deserve is: 1) better policy that enforces
10/ payers to provide access (hard) 2) one payer comes along and makes access to mental healthcare their competitive advantage …. and that becomes a new normal. Something has to change because America is on pace to be 26,930 mental health counselors short in 5 years.
