Behavioral Health

With midterm elections over, the soon-to-end 117th Congress will turn its attention to the biannual lame-duck session, and D.C. insiders say that health care items like reforms to telehealth and behavioral health care policies could be on the agenda. Meanwhile, the new Republican majority in the House of Representatives will soon hold inter-caucus votes on leadership roles, including Speaker of the House chairs — and those polls could dictate what is possible in health care policy when the 118th Congress begins work.

The lame-duck session is the final gathering of an outgoing Congress, a last hurrah for members who have been voted out or will retire. Such sessions revolve mainly around prosaic government funding bills, which must be passed in order to keep agencies running in the new year. They also offer a chance for urgent policy considerations to advance; additional COVID-19 funding and pandemic preparedness legislation could get a hearing during this year's lame duck, D.C. insiders tell AIS Health, a division of MMIT. A lame duck session will typically pass an omnibus spending bill, which D.C. wags joke is a "Christmas tree" — in many years, nearly every member gets to decorate the end-of-year package with their own pet amendment.

A new behavioral health venture that sprung from an innovative Horizon Blue Cross Blue Shield of New Jersey initiative is focused on embedding its integrated approach within other health plans and provider groups. NovaWell, a Horizon affiliate that launched Nov. 14, is offering a suite of technology-forward solutions aimed at tackling the country’s ongoing mental health crisis. Jolted into the public consciousness by the COVID-19 pandemic, the crisis is characterized by rising rates of anxiety and depression amid a shortage of trained professionals.

Backed by more than five years of testing and program design aimed at addressing the behavioral health needs of Horizon’s members, the NovaWell suite brings an integrated care management approach supported by network-enhancing solutions to a wider audience. Two of the company’s four core offerings, a fully integrated clinical model called NovaClinical and a network solution known as NovaNetwork, are positioned to bolster health plans, Suzanne Kunis, president and CEO of NovaWell, tells AIS Health, a division of MMIT.

A recent survey from UnitedHealthcare found that 71% of respondents said they would likely use virtual care in the future, up from 53% in last year’s survey. Donna O’Shea, M.D., UnitedHealth’s chief medical officer of population health, tells AIS Health that the results indicate the use of virtual care is more than just a COVID-19-specific trend and is likely to become a permanent part of health care.

Still, that’s not to say that people prefer virtual care over visiting doctors in their offices. In fact, the 2022 UnitedHealthcare Consumer Sentiment Survey found that 60% of respondents preferred in-person appointments for non-emergency issues such as allergies, flu or rashes, while 26% preferred virtual appointments and 14% had no preference. The question assumed that the quality and costs of care were comparable between in-person and virtual settings.

More than half of Medicaid managed care organizations have health equity strategies for some of their members, while four in 10 have health equity plans for their entire membership, according to a survey from the Institute for Medicaid Innovation (IMI). The survey found that 48% of MCOs have pursued health equity accreditation from the National Committee for Quality Assurance (NCQA), with 33% “planning to pursue” the accreditation. And 14% have no plans to do so, while 5% didn’t respond. Meanwhile, 86% of MCOs have “programs/policies for health plan internal staff” that are meant to address structural racism or promote racial equity, and 48% have policies for members that do the same. Outside of racial equity concerns, other notable findings from the survey include widespread problems with care coordination and telehealth delivery: 71% of responding MCOs said “access to information from previous providers [is] a key barrier to care coordination,” while 67% said “their information technology systems were a barrier to setting up effective telehealth delivery services.”

Highmark Health recently implemented a medical policy stating the insurer will cover digital prescription therapeutics (DPTs) under certain circumstances. The decision is “incredibly significant for our industry,” Akili Interactive Labs chief executive and co-founder Eddie Martucci, Ph.D., writes in an email to AIS, a division of MMIT.

Highmark’s policy pertains to Akili’s EndeavorRx treatment for children with attention-deficit/hyperactivity disorder as well as the eight other FDA-approved DPTs, which are software-based therapies to treat medical and behavioral conditions. DPTs treat conditions such as substance use disorder, opioid use disorder, irritable bowel syndrome and chronic lower back pain.

Highmark Health recently implemented a medical policy stating the insurer will cover digital prescription therapeutics (DPTs) under certain circumstances. The decision is “incredibly significant for our industry,” Akili Interactive Labs chief executive and co-founder Eddie Martucci, Ph.D., writes in an email to AIS, a division of MMIT.

Highmark’s policy pertains to Akili’s EndeavorRx treatment for children with attention-deficit/hyperactivity disorder as well as the eight other FDA-approved DPTs, which are software-based therapies to treat medical and behavioral conditions. DPTs treat conditions such as substance use disorder, opioid use disorder, irritable bowel syndrome and chronic lower back pain.

While some state officials have had more success than others, most states struggle to enforce mental health parity requirements set by federal law, according to a new report from the Georgetown University Center for Health Insurance Reforms (CHIR) and the Robert Wood Johnson Foundation (RWJF). One of the report’s authors and a mental health patient advocate both say that states need more resources to enforce parity requirements.

State officials have the responsibility of enforcing federal statutes such as the Mental Health Parity and Addiction Equity Act (MHPAEA) in the individual and fully funded employer health plan markets. Many states also have their own parity statutes as well. However, as the report puts it, “federal and state regulators have found that enforcing the complex law is challenging. While insurers’ quantitative barriers to treatment such as cost-sharing or visit limits can be relatively straightforward for regulators to assess, certain ‘non-quantitative’ treatment limits [NQTLs], such as the use of prior authorization, provider reimbursement, and formulary design are much more difficult.”

Recently, the Biden administration approved a pair of wide-ranging Medicaid waiver demonstration programs in Massachusetts and Oregon, granting those states authority to test unique policies such as keeping certain populations enrolled in Medicaid for more than a year and covering clinically tailored housing and nutritional supports. Medicaid managed care plans that serve Massachusetts and Oregon tell AIS Health that they’re planning to play a major role in helping to implement the new waiver programs, which will allow them to expand some of the social-needs-based interventions that they’re already providing and reduce the enrollee churn that can stymie care-management efforts.

Demand for mental health care has ballooned since the onset of the COVID-19 pandemic, and lawmakers from both parties have introduced legislation designed to improve access to such care. But while the idea of increasing access to mental health care is appealing to virtually all members of Congress, there is a tangle of policies that could achieve it, and legislators haven’t been able to agree on which threads should be spun into a high-profile reform bill. One such proposal that is backed by the White House and just passed the House of Representatives — H.R. 7780, the Mental Health Matters Act (MHMA) — was attacked by employer plan sponsors this week.

Congress seems poised to act on mental health issues this year, Joel White, president of Horizon Government Affairs, tells AIS Health, a division of MMIT. White is a veteran lobbyist and a former Republican staffer in the House of Representatives. The House has passed several mental health measures — including, on Sept. 28, H.R. 7780 — but the Senate’s work is moving at a slower pace.

The federal government and patient advocates have directed withering criticism regarding behavioral health coverage toward health plans in recent months. AHIP, the health insurance industry’s largest trade group, responded this week with a statement from its board emphasizing its commitment to equitable access to mental health benefits.

In January, the federal agencies that regulate health plans published a biannual report which found that health insurers have systematically failed to document the level of mental health care access they provide to members. That documentation is part of a yearslong federal effort to make plans comply with mental health care parity laws, which stipulate that health plans are not allowed to impose benefit limitations — non-quantitative treatment limits (NQTLs) — on mental health care that are more severe than limits placed on medical and surgical benefits.