In the United States, it is estimated that over 50% of adults with a mental illness do not receive treatment. The consequences of untreated mental health conditions – including unnecessary disability, unemployment, substance abuse, homelessness, and even suicide – have been estimated to cost the nation more than $100 billion annually. Seeking out behavioral health services has historically been stigmatized, causing people to forego care due to feelings of shame or embarrassment. Over the past two years, however, demand for care has been steadily climbing. An analysis of data in MercerFOCUS, which warehouses the claims of over 1 million health plan members, found a substantial increase in the number of people accessing outpatient behavioral health services – from 73 members/1,000 in 2019 to 83 members/1,000 in 2021. It is particularly interesting that telemedicine visits for behavioral health care – essentially non-existent prior to the pandemic – were utilized by 39 members/1,000 in 2021.
Three factors driving increased utilization
There are likely many reasons that utilization of outpatient behavioral health services has risen, but three stand out. First, the pandemic created personal challenges for countless individuals. Some people are coping with the loss of family members or friends. Many working parents have had to juggle expanded caretaking duties, leading to missed deadlines, stress and burnout. Even just shifting from in-person to remote work can be isolating and blur the lines between work and free time. Data from the World Health Organization shows that the coronavirus pandemic increased the prevalence of anxiety and depression by 25% worldwide.
Second, in response to the growing need for support, employers stepped up efforts to improve access to mental health support. Health benefit offerings are integral to attracting and retaining talent in the workforce, and mental health benefits are an increasingly valued component. Behavioral health has jumped to the top of the priority list for the nation’s largest employers: In Mercer’s 2021 National Survey, expanding access to behavioral health was rated “very important” by 59% and “important” by 27%.
Finally, many new virtual care options have entered the market and are proving popular. Employers can now draw on both traditional telehealth vendors and specialized behavioral health programs as they seek to expand behavioral health care access for members. Many people tried telebehavioral health care for the first time during the pandemic lockdowns and liked it. Virtual care offers greater convenience – no travel time – and often better access. Where patients may have to wait weeks to see a provider in person, many virtual platforms offer appointments within 24 hours or less. For example, Ginger, an on-demand mental health platform, reports that they connect 80% of their members to a care coach within 2 minutes.
There are no signs that demand for mental health services will diminish – and given the human and financial costs of unmanaged mental illness and substance abuse, employers should continue to encourage this trend. Here are some considerations for employers planning ahead to meet this important workforce need.
Close the gap to ensure mental health access. While rising utilization of behavioral health services is encouraging, more must be done to close gaps in access to care. Notably, only 58% of low-earning employees reported having access to mental health counseling services in 2021, compared to 73% of high earners. This contributes to health disparities across racial and ethnic groups. To expand coverage for low-earning individuals, employers can opt into an affordable virtual care option within an existing medical plan or add supplemental mental health benefits through an employee assistance program or third-party vendor.
Ensure access to high-quality care. Simply providing behavioral health care coverage isn’t enough – employers need to ensure members have access to high-quality care that meets their needs. Dr. Alethea Varra, clinical psychologist and Vice President of Clinical Care at Lyra Health, has this advice: “Don’t settle. Ask the hard questions and push for really high-quality care.” Employers can survey members to understand the types of mental health services they need and use clinically validated measurements to assess improvements in outcomes.
Keep telebehavioral health services affordable. While virtual behavioral health visits are still more affordable than traditional visits, the price gap has narrowed over the past three years. Virtual behavioral health care can provide better access for marginalized groups due to its convenience, timeliness, and affordability compared to in-person visits. Employers should focus on keeping telebehavioral health services affordable to encourage use in the most vulnerable and high-risk populations.
Expand virtual mental health care options for employees. Virtual care addresses many of the limitations of in-person care by improving access and care options for people in rural or underserved areas and eliminating long wait times and travel. And, as Dr. Varra notes, it makes treatment available to caregivers who might otherwise go without: “[I]f they can find a private place within their home then they can receive the care they need.” Further, many telebehavioral health solutions offer valuable services beyond one-on-one therapy. For example, Modern Health offers guided meditation, self-guided resources for building healthy habits, and certified coaches or group learning sessions to help individuals achieve their goals. With many vendors to choose from, employers can seamlessly integrate different forms of high-quality, clinically significant care in their programs.
Employers have made good progress in expanding access to quality behavioral health care, and providing various options for different care needs, but there is still work to do. Your benefit plans likely include telebehavioral health, but are you getting the most out of the expanded access? Now is a good time to evaluate how well telebehavioral health is meeting the needs of your population.
Leah Salzano, a Master of Public Health candidate at Yale University in New Haven, interned with Mercer this summer. One project was to use the Mercer Focus data warehouse to study trends in outpatient behavioral health care and consider the role of new forms of virtual behavioral health care. In the course of writing this article, she spoke with Bobbi Bohnsack and Dr. Alethea Varra from Lyra Health, Bryan Vercler from Modern Health, and Jessy Paull from Ginger, all of whom provided valuable insights.
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