May is Mental Health Awareness Month
Compiled by Thora Madden
If the past two years of a global health crisis have taught us anything, it’s that MENTAL HEALTH is fragile and extremely important to protect. Human beings are social creatures, and the lockdowns, isolation and existential dread have taken their toll on even the sunniest of dispositions.
We wanted to get a perspective on how the industry is responding to this demand for care for our tenderest of organs — our brains and mental wellbeing. These thought leaders give us a unique perspective on what’s happening, how experts are addressing it, and where brokers can play a roll.
California Broker (CB): Describe your company’s role or products in the behavioral health space.
Kim Rudeen, VP of Product Development & Management, Aflac
“From mental health riders to value-added services and benefits for caregiving, there are many ways that supplemental benefits are caring for the whole policyholder. Take time to help insured individuals understand how they can take advantage of these benefits from day one.”
There is a noticeable gap in behavioral health and insurance coverage. Aflac is committed to helping to close this gap. These are some of the ways we’ve sought to make a difference by providing mental and behavioral health care for insured individuals:
- Aflac’s new group critical illness product, launched in April 2022, offers a mental illness rider that covers serious mental illnesses, including bipolar disorder, post-traumatic stress disorder, substance use disorder, major depressive disorder and schizophrenia. Health screenings, including mental health exams that can help detect potential problems before they become more harmful, are also available.
- Earlier this year, Aflac partnered with NeuroFlow to offer a program for its Group Long-term Disability policies with 1,000 or more covered lives. The program offers access to NeuroFlow’s mental health and well-being application that screens and monitors existing and undetected behavioral health conditions. This solution is designed to help close the gap that may exist in an employer’s behavioral health program by proactively helping individuals self-detect potential issues like depression, anxiety, sleep disorders and more.
- In January 2016, Aflac partnered with MeMD to offer telehealth services for treatment of mental health disorders. It has become our No. 1 value-added service in the individual market since smaller employers often don’t offer major medical. It is also popular with groups that have major medical insurance because it gives employees access to lower copays for urgent care and therapy needs. Lower costs can help incentivize employees to seek care when they need it, which subsequently helps control premium increases year over year.
- Aflac’s individual accident policy has evolved to include a benefit to support families, if they need to take time off from work to care for their child who is hospitalized, for instance. This helps increase family well-being and caring for the caregiver.
Rick Porterfield, regional director, Pacific Northwest and Southwest, Guardian Life
“As our recent Guardian workplace study Mind, Body, and Wallet found, almost half of working Americans believe their employer isn’t doing enough to address concerns about workforce mental health. In contrast, 70% of employers believe they do an excellent job addressing workforce emotional health, so there is a disconnect in perception. This disconnect means that communication about benefits from employers is critical”.
In 2021 we invested in and form-ed a strategic partnership with Spring Health, a leading behavioral health services provider that directs companies and employees to optimal mental health care. The Guardian Spring Health plans are personalized and provide members access to mental health professionals. Included are a wide range of solutions clinically proven to reduce recovery times while also helping companies decrease employee turnover and increase productivity.
Spring Health resources address a wide range of problems such as anxiety, depression, stress, burnout, sleep issues, relationship difficulties, eating disorders and substance abuse. Care plans available to employees and family members include in-person and virtual appointments with licensed care providers, digital Cognitive Behavioral Therapy (CBT), coaching, mindfulness exercises, and more. To learn more about the plans Guardian offers to support mental and emotional well-being, please go to guardianlife. com/spring-health.
Guardian also offers an Employee Assistance (EAP) program through Uprise Health, which has provided critical mental wellness resources for millions of Guardian members for more than 20 years. In addition to traditional EAP services including coaching and clinical resources, the Uprise EAP was recently enhanced to include new Cognitive Behavioral Therapy (CBT) options.
Maria Villarosa, MD, assistant regional medical director, Behavioral Health Service line leader, Psychiatry chief of service Riverside, Kaiser Permanente
“The prolonged state of the pandemic will continue to have lasting effects on our nation’s mental health, most acutely among young adults and caregivers who have experienced the largest increase of stress and anxiety.”
Kaiser Permanente’s integrated system – which offers care and coverage together is uniquely built to meet our members’ needs. It enables us to provide a comprehensive level of mental health care not available with any other health plan. We draw from a full spectrum of proven care from primary care to specialty mental health care, to emergency care, and everything in between. We act as a front door for our patients and help them navigate various culturally competent treatment options, all under one roof. This enables us to provide our members flexibility to receive care in the manner that best suits them: remotely – by telephone, video, or online, using a variety of tools and resources as well as in-person.
Our integrated system is something we are very proud of as it supports the complexity of mental health care and acknowledges that no treatment is one size fits all. Our focus on measurement-driven treatment along with the tailored coordination of our care teams lead to high quality outcomes for our patients. Additionally, Kaiser Permanente believes in preventive medicine. So we have created programs to help patients better understand the challenges they face by offering asynchronous educational series and live webinars (available in both English and Spanish) which discuss an array of mental health topics. We make it a priority to offer a seamless entry pathway to care through our central call centers. These help connect members to digital resources such as myStrength, Calm, and Ginger, educational classes, individual therapy and medication evaluations. We encourage ongoing feedback from our members to help us understand what tools, therapies and self-care techniques are working, what additional things need to be addressed, and what the path forward looks like after achieving treatment goals. The result is a fluid care experience that evolves with each member’s needs.
Randall Solomon, MD, DLFAPA, FASAM, Senior Behavioral medical
director for Optum
We have a distinctive role to play in the transformation of a more sustainable behavioral health system for today and into the future. We bring together technology, clinical expertise and strategic partnerships to ensure more people have access to quality, supportive behavioral health care services and are able to live better with these conditions.
“Addressing mental and emotional health concerns is especially critical among older adults,” Dr. Bhatnagar said. “You have
to safeguard your mental health the way you would any other body part and when something feels off, it’s time to get a professional opinion.”
UnitedHealthcare is the leader in health benefits, driving affordable coverage, simplifying the health care experience, addressing consumer health and social issues, and delivering access to high-quality care. We serve people from their earliest years through their working lives and into retirement. What unites us is our mission to help people live healthier lives and to help make the health system work better for everyone
We are expanding access to care in our community. Too often, communities have limited resources to provide mental health care for their population. We believe we have a responsibility to make it easier for people to get the care they need.
Our partnerships and grants enable organizations to:
- Train and hire behavioral health clinicians and specialists, including diverse and culturally competent providers
- Provide virtual counseling to low-income or uninsured patients, including children
- Establish school-based behavioral health services including early intervention screenings
- Support parent coaching and intervention programs to improve parent-child relationships, promote mental health and reduce stigma
- Enable peer-to-peer support to encourage personal connections and decrease feelings of isolation and loneliness among at-risk populations including seniors and veterans.
Since 2019, UnitedHealth Group has invested over $36M in more than 50 strategic behavioral health philanthropic partnerships.
Ted Hong, chief engagement officer, Solera Health
“Awareness and choice are key for consumers to understand and utilize behavioral health benefits. Brokers and benefits professionals must provide their clients with information explaining all of the benefits available to them.”
Solera’s platform matches consumers to digital health solutions for personalized treatment and creates a centralized interface for accessibility and engagement. We ensure that people are getting the right level of support based on data monitoring of treatment progression. In addition, we provide payers and employers with the tools they need to manage these programs with only one agreement.
Solera simplifies difficulties in launching programs, including claims processing, consumer engagement, eligibility screening and vendor management. Some of our specific programs include Diabetes Prevention, Weight Management, Mental Health, Musculoskeletal, Social Isolation, Tobacco Cessation and Digestive Health.
CB: The pandemic changed life and business for most people. Describe how it impacted your services and anything relevant that’s happening now.
The pandemic has had a significant impact on the way we live and work. We saw insured individuals staying closer to home for everything work, school and play. Less travel and activity away from home means less potential for accident and injury. Large scale events like marathons and other team sports came to a halt or were drastically reduced in terms of participation, resulting in fewer of those “weekend warrior” injuries. As life picks back up for many, we anticipate typical injuries and accidents coming back to pre-pandemic levels.
We also saw a drop in regular health screenings. Cancer and other serious illnesses didn’t take a break during the pandemic. Delayed screenings can mean they aren’t detected as early. People with poor mental health are more likely to have a physical condition, so that’s why mental and physical health screenings go hand in hand.
Because of the pandemic, consumers are concerned about critical illnesses that can be related to COVID-19 diagnosis and treatment. They are also showing more concern overall about the unexpected expenses that could come from being sick, injured or admitted to the hospital. For instance, our 2021-2022 Aflac WorkForces Report found that almost half of all employees purchased at least one new benefit directly because of the pandemic. Naturally, life insurance, critical illness insurance and mental health resources top the list, but accident insurance and disability insurance are also part of the mix of benefits that consumers purchased because of the pandemic.
Porterfield, Guardian Life:
We mobilized to address the impact of the COVID-19 pandemic on our customers and colleagues.
The disruptions it brought led us to reexamine many elements of our business and create a comprehensive plan to make our company stronger and better.
Notably, we were one of the first carriers to offer pandemic support to our customers. This included premium credits and rate guarantee extensions as well as removal of claim requirements from rollover fund eligibility on impacted dental plans. We also offered eligibility extensions, many above and beyond state requirements, to employees who were affected by pandemic related furloughs and layoffs. Additionally, we were the first carrier to extend wellness benefits on applicable Supplemental Health products to treat COVID-19 testing as a covered service.
Finally, and importantly for our members and their families, our financial strength has been reaffirmed during a time of increased need: We paid $7.4 billion in total benefits, an 11% increase over 2020, including $1.9 billion in life insurance claims, $200 million of which are COVID-19 related.
Villarosa, Kaiser Permanente:
Two years into the pandemic, the biggest impact on our behavioral health services continues to be the rise in demand. The prolonged state of the pandemic will continue to have lasting effects on our nation’s mental health, most acutely among young adults and caregivers who have experienced the largest increase of stress and anxiety. Early in 2020, we moved quickly to shift delivery of nearly 100% of our scheduled mental health services to telehealth options. In the time since, we have invested in developing additional resources for an increasingly diverse set of patients seeking mental health care. During the pandemic, mental health awareness and care became a larger part of our national conversation.
This conversation made seeking mental health care more acceptable and awakened a whole new group of people seeking care. With this new population, we found that Kaiser Permanente was in a unique position, given our integrated system, to help patients understand their symptoms and their needs and develop treatment plans to set them on a path to recovery. The pandemic highlighted the strength of our approach, but it also challenged the system and our clinicians as we continue to manage an incredible increase in members seeking care. We recognize that this pressure is directly felt by all our front-line staff and physicians, including our mental health clinicians. This is why we implemented “Rise and Renew,” an internal program focused on making sure we are taking care of our frontline employees. As we focus on investing and building programs for members, we are equally focused on developing and building our own future workforce to meet the full needs of mental health care.
As part of the company’s response to COVID-19, The United Health Foundation provided a $1M grant to the American Nurses Foundation to help build a virtual support system and promote mental health and resilience among front-line nurses.
It may not be surprising that the use of telehealth has jumped over the last year. With more people spending time at home, the number of older adults who had at least one telehealth visit increased substantially from just 4% in 2019 to 26% in 2020.
With telehealth adoption comes greater access to clinical experts, including for virtual mental health care. During the pandemic, a growing number of people reported symptoms of anxiety or depression.
Psychiatrists and other mental health counselors have also seen a greater influx of patients in the past year.
The benefits Dr. Saurabha Bhatnagar, chief medical officer and head of digital & technology for UnitedHealthcare, said it’s encouraging that more people are taking advantage of virtual mental health services and seeking the help they need.
“As we are more than a year into the pandemic, we know the short- and long-term toll this has taken on people’s emotional well-being,” he said. “Immune systems don’t function as well when we’re feeling down, so seeking help is critical for maintaining overall health.”
This also allows a wider range of specialists who may be available, thanks to the virtual component. In fact, a third of psychologists said they are working with patients who live in a different state than their own.
A virtual conversation focused on improving emotional health may also be more private, comfortable and convenient from home — not to mention the potential cost savings. For eligible UnitedHealthcare Medicare Advantage plan members, telehealth visits are covered at no additional cost.
Opening the (virtual) door
These possible advantages are especially important to Medicare members over 65. One in four seniors in this population are estimated to be suffering from a mental health disorder — a figure that is expected to double by 2030.
“Addressing mental and emotional health concerns is especially critical among older adults,” Dr. Bhatnagar said. “You have to safeguard your mental health the way you would for any other body part and when something feels off, it’s time to get a professional opinion.”
He added there are several stressors seniors may face as they age, including an evolving purpose when entering retirement, changes in health status or a change in financial resources. These issues may be addressed through teletherapy in order to help ease anxieties and discover coping techniques.
In stressful times, it may be difficult to manage symptoms. Here are some ways to help find care and support.
- A free 24/7 emotional support line is here for you to call any time at 1-866-342-6892. This Optum Help Line is staffed by professionally trained mental health experts. It is free of charge and open to anyone.
- An on-demand emotional support mobile app called Sanvello is available to many UnitedHealthcare members to help cope with stress, anxiety and depression. Eligible members must register using their UnitedHealthcare member ID card.
- The National Suicide Prevention Lifeline offers 24/7 support through an online chat called Lifeline Chat. You can also call 1-800-273-8255 or 1-800-799-4889 (TTY) for support.
- The Crisis Text Line is a free resource available 24/7 to help you connect with a crisis counselor. Text “Home” to 741741.
Hong, Solera Health:
The pandemic has driven health consumers to seek out digital, virtual care to protect themselves from exposure to the virus. Along the way, consumers grew even more comfortable accessing care through their devices. In tandem, the isolating effects of COVID-19 created a greater need for many of our programs, particularly our Mental Health and Social Connections offerings as conditions like anxiety and depression have accelerated due to social isolation.
CB: What should brokers and benefits people know and do to help clients better understand and utilize their behavioral health benefits?
Take time to help employers under-stand the needs of their workforce.
A few key data points include:
- Mental health negatively affected the job performance of one-third of the workforce in the past year.
- Women are more likely to have experienced burnout, and younger workers are most likely to say they are currently experiencing burnout.
- Most employers believe their workforce is financially able to meet their health care obligations, while many employees would struggle — 46% indicate that they would not be able to pay more than $1,000 in out-of-pocket medical costs.
From mental health riders to value-added services and benefits for caregiving, there are many ways that supplemental benefits are caring for the whole policyholder. Take time to help insured individuals understand how to take advantage of these benefits from day one.
Porterfield, Guardian Life:
As our recent Guardian workplace study Mind, Body, and Wallet found, almost half of working Americans believe their employer isn’t doing enough to address concerns about workforce mental health. In contrast, 70% of employers believe they do an excellent job addressing workforce emotional health, so there is a disconnect in perception. This disconnect means that communication about benefits from employers is critical, not only to remind employees about the resources available to them, but also to normalize mental well-being needs along with physical and financial well-being needs.
Significantly, last year Guardian launched partnerships with cutting-edge decision support provider Nayya Health to bolster engagement at enrollment and during life events throughout the year. We believe providing practical advice when employees are making benefit decisions at enrollment will help them better understand what their employers are making available to them. Nayya and our API program make enrolling in and accessing benefits easier, which helps our customers and members to take better advantage of offered products.
Moreover, to help our customers and members more fully utilize their Guardian Spring Health mental and emotional wellness benefits, we are integrating Spring Health into our claim processes, beginning with Short-Term Disability (STD) claims. Guardian members with Spring Health and STD benefits will have an opportunity to receive claims-specific outreach during their STD journey, connecting them with meaningful mental wellness resources at a difficult time in their life.
Villarosa, Kaiser Permanente:
We encourage brokers and benefits people to use our various online resources — including our mental health webpage (kp.org/mentalhealth) to learn more about our services, our online classes and webinars, and our virtual treatment tools — to better understand our behavioral health benefits. These serve as a great starting point because they help patients understand what they are going through, which we believe is an essential first step in seeking mental health treatment. Understanding what you are experiencing creates self-awareness allowing you to better communicate your needs. As patients move past the first steps in treatment, they can access multiple treatment methods, such as virtual and in-person one on one therapy and group therapy, or a combination of both.
One on one therapy is the most widely requested treatment, but we know that patients benefit greatly from various options, including group sessions with other members who have shared experiences. In addition, we have found that our emotional wellness support resources have been essential during the pandemic. Whether it’s to help with sleep, stress or relationships, we offer many digital resources for our members’ mental health and wellness, including popular wellness apps like myStrength, Calm, and Ginger. The myStrength app (a wholly owned subsidiary of Livongo Health, Inc.) offers a personalized program with interactive activities, in-the-moment coping tools, inspirational resources, and community support. Calm is a meditation and sleep app designed to help lower stress and reduce anxiety. Ginger (available in Southern California and coming soon across California) is an app with on-demand mental health support including coaching, therapy, psychiatry and self-care resources. These resources further demonstrate Kaiser Permanente’s unique integrated system which allows patients to utilize a spectrum of behavioral health benefits.
Enhancing and Evolving our Network
Optum delivers a comprehensive platform of coverage and care for behavioral health and wellness to over 35 million members across the spectrum of public, private and government payers and programs. Using evidence-based, data-driven insights and technology capabilities, Optum’s model is designed to fully integrate the physical and behavioral health needs of our members, supported by timely and national access, improved care quality, and better health outcomes.
We want people to know, we help people access the most appropriate care using evidence-based guidelines, just as we do for medical care. We develop our guidelines by consulting medical literature and the leading national medical and behavioral health communities, including the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA).
- 311,000+ BH providers and facilities in-network nationwide
- 73,000 virtual visit providers (combined BH and EAP)
- 3.5M members received behavioral health care in 2020, and 56% of UnitedHealthcare’s behavioral health visits took place virtually in 2020
- 4,500+ Express Access providers committed to seeing patients within 5 business days, compared to the industry average of 14 days
- 93% of our members are within 20 miles of an Express Access Provider
- More than 7,000 medication-assisted treatment (MAT) locations for members in need of substance use disorder (SUD) treatment
- More than 94% of members living within 20 miles of a MAT provider
Hong, Solera Health:
Awareness and choice are key for consumers to understand and utilize behavioral health benefits. Brokers and benefits professionals must provide their clients with information explaining all of the benefits available to them. A digital front door empowers health and wellness consumers to self-select the solution that will work best for their needs, therefore, payers that partner with Solera Health will expand understanding and access to a myriad of proven interventions.
CB: What is your company’s major focus or major concern as we look toward the next year or two?
Employees bring their whole selves to work. That includes everything they’re dealing with physically, mentally and financially, and the last year and half has been especially challenging. Aflac is working to meet today’s rapidly changing benefits needs with flexible coverage that helps take care of expenses health insurance doesn’t cover. Insured individuals can use their benefits to help with medical co-pays, deductibles and prescriptions or everyday living expenses like rent, utilities or child care.
Porterfield, Guardian Life:
As our CEO and President Andrew McMahon writes in our 2021 Annual Report, “In 2021, Guardian set a new strategic course, guided by an overarching purpose to inspire well-being. Our purpose flows through every action and decision we make and incorporates our colleagues, customers, and the communities we serve. We believe that dedicating ourselves to protecting and enhancing the well-being of all stakeholders will position us to grow and deliver superior value for decades to come. We are fulfilling our purpose to inspire well-being by advancing three strategic priorities: wow the consumer, reimagine mutuality, and unleash what’s possible. While we laid the foundation in 2021 to advance these aims, our vision is far-reaching, and our efforts will extend into 2022 and beyond.”
Villarosa, Kaiser Permanente:
Addressing the growing demand for mental health and addiction care services continues to be our top priority and main area of concern. We recognize this is a national issue and are focused on investing in solutions that will result in high-quality outcomes for both our employees and our patients. Leaning on our uniquely integrated system, we are exploring solutions that consider the complexities of mental health care and offer meaningful improvements for employees and patients alike. From a workforce perspective, one of the biggest issues affecting our ability to meet demand is staffing. Much like the national mental health crisis, there is a well-known healthcare staffing crisis in the U.S.
That is why we are focused on building our workforce from within. Our Mental Health Scholars Academy, which is active in California, is an initiative that attracts a diverse talent pool from within Kaiser Permanente to train new mental health care professionals. This initiative coupled with increased investments in recruitment will help us to begin to alleviate pressures our current clinicians face. We are also focused on addressing the issues that impact patient demand for care such as wait times and access to clinicians of similar background and/or belief. We continue to invest in virtual and online resources which allow patients to access care in a more timely manner and distribute demand throughout our network. With each of these investments, we remain focused on delivering care that is both feedback and outcomes based which will continue to ensure quality care.
Demand for behavioral health services outstrips access to care, particularly in rural areas, for populations facing health disparities and for certain provider specialties. Also, a lack of integration across physical and behavioral health providers can result in fragmented care. Quality of care and treatment effectiveness can be impacted by lack of adherence to evidence-based guidelines and measurement of health outcomes. The total cost of care is three to five times higher for patients with co-occurring physical and behavioral health conditions compared to those without.
We are meeting this challenge by delivering a comprehensive platform of coverage and care for mental health, SUD and behavioral wellness. We use a model designed to fully integrate the physical and behavioral health needs of our members, supported by timely and national access, improved care quality, and better health outcomes.
- Increasing access to high-quality and consumer-driven behavioral health care through a national, high-performing provider network that gives members seamless access to timely care and support — in person and virtually. By designing care experiences around the person, we’re creating optimal pathways that help align care with the needs of the member. We use a range of options to deliver treatment and wellness solutions though digital therapeutic platforms and applications, virtual telepsychiatry and teletherapy, traditional brick-and-mortar specialty treatment, as well as integrated primary care.
- Improving quality of care by integrating behavioral and primary care, aligning payer and provider incentives to better manage care, and offering a full range of care delivery solutions — such as digital health tools, care at home, virtual care, and primary and specialty care locations — to meet consumers’ needs and preferences.
- Lowering total cost of care and improving health outcomes by blending analytics and care delivery capabilities to manage total health care costs while improving health outcomes by:
- Utilizing advanced analytics to enable rapid interventions at the right level of care
- Leveraging our pharmacy capabilities to improve medication adherence and medication access through partnerships with Community Mental Health Centers
- Improving the patient and provider experience and lowering costs by embedding behavioral care clinicians with primary care practices to better serve patients
- Reducing low-value behavioral health care by implementing measurement-based care that rewards optimal outcomes and positive patient and provider experiences.
Hong, Solera Health:
Moving forward, Solera’s main focus is to continue curating partnerships with like-minded payers and employers to maintain outstanding behavioral health programs and continue to provide people with accessible treatment. In the pipeline are several other conditions that will be added to the platform later in the year. We are very excited to help our populations reach their mental health goals and more for the rest of this year and beyond.
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