Ensuring Mental Health Parity and Access Peter Bri Peter rickwed - - PowerPoint PPT Presentation

Peter Peter Bri rickwed edde

Assistant Commissioner of Government and External Affairs, Minnesota Department of Commerce

Sh Sharon G Gabr brie ielson

Executive Leader, Former Chair of Mayo Clinic Global Business Solutions and Former Vice Chair of Mayo Clinic Health Systems (Moderator)

Tra Travis is (T.J T.J.) .) Gra ray, , F.S .S.A .A., ., M.A .A.A .A.A .A.

Consulting Actuary, Milliman

Clai Claire Neely ly, M.D., F.A.A.P.

President & CEO, Institute for Clinical Systems Improvement (ICSI)

Ensuring Mental Health Parity and Access

MINNESOTA HEALTH ACTION GROUP 2020 SUMMIT APRIL 2020

T.J. Gray, FSA, MAAA

Discussion Panel

Ensuring Mental Health Parity and Access to Care

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Milliman’s Focus in Behavioral Health

Mental Health Parity Compliance

§ Quantitative Testing § NQTLs § Access to care § Payment rates § Compliance guidelines

Financial Analysis Program Design and Evaluation

§ Rate setting and negotiation

support

§ Financial projections § Cost and utilization

benchmarking

§ Fee schedule evaluation § Integrated medical-

behavioral healthcare

§ Alternative payment models § Policy analysis and special

topics research

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Recent Milliman Research – Behavioral Health

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Recent Milliman Research - OUD

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Parity primer

Quantitative treatment limitations (QTLs)

• Financial requirements (copays, coinsurance, deductibles)
• Benefit limits (visits, dollars)
• Black and white mathematical tests: the “predominant” level for

“substantially all” medical/surgical care can be applied to behavioral care

• Comparatively easier to evaluate, demonstrate compliance

Nonquantitative treatment limitations (NQTLs)

• Any other processes, standards, policies, etc. that limit behavioral care.
• Examples: prior authorization, medical necessity criteria, step therapy,

provider payment rates, utilization management criteria, etc.

• Gray area: Limitations for behavioral care should be “comparable to and

no more stringent than” those applied to medical/surgical care, both “as written” and “in operation”

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Recent Milliman Research – Impact of MHPAEA

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Encouraging trends – benefit richness

Improvements in “benefit richness” for commercial PPO plans, 2008-2013

1.1% 1.2%

• 2.5%

1.2% 4.8% 6.1% 6.2% 3.9% Inpatient facility Outpatient facility Professional Total

Medical/Surgical Behavioral

Source: Melek S, Perlman D, Davenport S, et al. Impact of Mental Health Parity and Addiction Equity Act. Milliman, November 2017.

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Encouraging trends – use of behavioral services

Average annual utilization trends for commercial plans, 2008-2013 HMOs PPOs

1.0% 4.1% 4.4% 6.4% 18.9% 5.9% Inpatient facility Outpatient facility Professional Medical/Surgical Behavioral

• 1.1%

2.0% 3.1% 10.7% 19.5% 9.4% Inpatient facility Outpatient facility Professional Medical/Surgical Behavioral

Source: Melek S, Perlman D, Davenport S, et al. Impact of Mental Health Parity and Addiction Equity Act. Milliman, November 2017.

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Recent Milliman Research - NQTLs

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Key findings from NQTL Analysis

Source: Melek S, Davenport S, Gray, TJ. Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement. Milliman, November 2019

§ Out-of-network utilization rates for behavioral healthcare providers were higher than for medical/surgical providers in all five years and has increased across settings. § Average in-network reimbursement rates for behavioral health office visits are lower than for medical/surgical office visits. § Disparities in out-of-network use for SUD compared to M/S care are stark and have increased over the five-year study period. § Disparities in out-of-network utilization for office visits are greater for children than for adults, even as disparities related to reimbursement levels are greater for adults than children. § Improved access to behavioral healthcare services could reduce overall healthcare spending, because spending for “physical health” is approximately 2-3 times higher for patients with any ongoing behavioral health diagnosis.

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Room to improve – network access

Higher proportion of out-of-network care for behavioral vs. medical/surgical in commercial PPO plans, 2013-2017

Source: Melek S, Davenport S, Gray, TJ. Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement. Milliman, November 2019

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Room to improve – provider payment rates

Office visits - percentage higher in-network reimbursement for primary care providers and medical/surgical specialists compared to behavioral providers in commercial PPO plans, 2013-2017

Source: Melek S, Davenport S, Gray, TJ. Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement. Milliman, November 2019

Peter Peter Bri rickwed edde

Assistant Commissioner of Government and External Affairs, Minnesota Department of Commerce

Sh Sharon G Gabr brie ielson

Executive Leader, Former Chair of Mayo Clinic Global Business Solutions and Former Vice Chair of Mayo Clinic Health Systems (Moderator)

Tra Travis is (T.J T.J.) .) Gra ray, , F.S .S.A .A., ., M.A .A.A .A.A .A.

Consulting Actuary, Milliman

Clai Claire Neely ly, M.D., F.A.A.P.

President & CEO, Institute for Clinical Systems Improvement (ICSI)

Ensuring Mental Health Parity and Access