In a review of claims data for almost 100 Mercer employer clients, representing approximately 2.5 million members, we found that the Mental Health and Substance Abuse per member per year cost trend (for allowed charges) rose nearly 11%, in stark contrast to overall medical PMPY trend of 3.5%. And while MH/SA claims represent a small percentage of the overall medical claim costs (4%), a spike in the cost may be a symptom of a larger issue – and an opportunity for employers to get out in front. What’s driving this trend?
One factor behind the increase in OON utilization may be adult dependents added under the ACA, who tend to live outside the primary member’s area and use OON services at a higher rate.
But the biggest driver of increased OON utilization may simply be limited access. Mental Health Parity has increased both visibility and pressure to increase access. We are seeing members access care more than ever before. And more employers are recognizing the importance of behavioral health in the benefit offering; they are increasing the number of EAP visits allowed and adding onsite counselors. Some specialty areas in particular experience access issues, such as psychiatry – both adult and child/adolescent.
The shortage of providers has led a growing number to choose not to join networks -- because they don’t have to. With access to in-network providers limited not just in rural markets but also in busy urban areas, more plan members may be making a choice to use out-of-network providers, albeit at a lower benefit level.
What are the possible interventions?
But before you start down any of these paths, look at your data to find out:
The more answers you have, the better equipped you will be to develop an approach that strikes the right balance between what people need and how the plan meets those needs.