Provider networks and prior authorization requirements may be levers "available to health plans to manage care in ways that might dissuade people from getting treatment," researcher says.
Despite much more insurance coverage than in the past, patients with behavioral health needs are not getting the treatment they need, according to a recent study.
The Patient Protection and Affordable Care Act (PPACA) was supposed to improve access to mental health services by making sure those in need had the insurance coverage to pay for treatment. But there are still barriers that have not been overcome by simply having insurance coverage.
Researchers from Brandeis University and Harvard Medical School analyzed National Survey on Drug Use and Health data from 2005 to 2014 to estimate how many people were likely to face "serious psychological distress," a specific level of mental health need that the Centers for Disease Control and Prevention estimates affects about 3.3% of non-institutionalized Americans.
The researchers used that 3.3% figure as a general estimate of how many people need mental illness access care. Then then they measured how many people actually received mental healthcare.
Even a single inpatient, outpatient, or pharmacy visit was considered mental healthcare.
The findings were published in Health Affairs this month.
Better Access Seen, But Not for All
There was some improvement in access to behavioral healthcare after the ACA was enacted in 2010, but only for certain groups, says lead author Timothy Creedon, a PhD candidate at the Heller School for Social Policy and Management at Brandeis University.
Racial divisions were significant, with whites the only racial group in which a majority of people needing mental healthcare received treatment. Whites with mental health needs also saw access to mental health services grow significantly, from 50% to 55% after ACA.
For Hispanics and Asians, access to mental healthcare improved after 2010, but only at about the same rate it was growing before the law came into effect.
Access for blacks did not change at all. Across all racial groups, less than half of people with serious psychological distress get the treatment they need, the authors concluded.
How can that be if more people have insurance coverage now?
Creedon says the problem appears to be partly the result of consumers not knowing about or understanding the coverage they have.
"When we ask people with private insurance, as many as 25% to 30% of people will say they don't know," Creedon says.
"That suggests that simply having the coverage doesn't improve anything unless the person knows and understands how to take advantage of the services available."
Treatment Limits a Barrier
Although health plans seem to be complying with the ACA requirements and the Mental Health Parity and Addiction Equity Act of 2008, Creedon says non-quantifiable treatment limits still are getting in the way of treatment for some insureds.
"Provider networks, prior authorization, and things like that may still be levers that are available to health plans to manage care in ways that might dissuade people from getting treatment," Creedon says.
"We also have problems with shortages and distribution of mental health providers, who tend to be located in urban centers and not so much in rural areas. The workforce in mental [health] tends to be relatively homogenous and not necessarily reflective of the demographics of the people seeking treatment, and that can be a deterrence."
Creedon also notes that psychiatrists are the physicians least likely to accept insurance.
He notes, however, that the research period came before the Medicaid expansion and state-based health insurance exchanges, and both may have improved access to mental healthcare, he says.
Health plans also are recognizing the disparity in coverage and treatment, Creedon says.
"We're seeing some health plans offer more case management and integrated care, which can help people get access to mental health [services] through their primary care office, and some plans are offering more reimbursement for that kind of thing," Creedon says.
"I think if we see more financial encouragement of integration, that will be one way to get needed care to people."
Gregory A. Freeman is a contributing writer for HealthLeaders.