Behavioral Health

Although U.S. employers already contract with a bevy of health and wellbeing vendors, a recent survey found that nearly nine in 10 are planning to make changes to their vendor partnerships in the next two years — chiefly by adding or enhancing current offerings. As companies do so, health insurers have a critical role to play when it comes to integrating various solutions and helping employees find them, an employee benefits expert says.

Employers’ desire to add and enhance health/wellbeing offerings “doesn’t look like it’s going to stop anytime soon,” says Regina Ihrke, senior director and health, equity and wellbeing leader at WTW. Therefore, large medical benefits carriers “are going to have to continue to be nimble and flexible in who they partner with, and then how they also integrate with other carveout solutions that are out there,” she tells AIS Health, a division of MMIT.

About 16.6% of in-network claims were denied by non-group qualified health plans (QHPs) offered on HealthCare.gov in 2021, down from 18.3% in 2020, according to a recent Kaiser Family Foundation analysis. Among the 162 issuers in HealthCare.gov states with complete data on claims received and denied, 65 of them had a denial rate between 10% and 19%. Only 17 issuers had a denial rate over 30%, compared with 28 in 2020. The majority of denials (76.5%) were classified as “all other reasons,” while 8% were for services that lacked a prior authorization or referral. Of the more than 48 million denied claims in 2021, marketplace enrollees appealed 90,599 claims — a 0.2% appeal rate — and insurers upheld 59% of denials that were appealed.

With two recently debuted product offerings, a pair of health care companies aim to solve a problem that has been thrown into sharp relief during the ongoing pandemic: highly variable — and often inadequate — access to behavioral health care services. Industry observers say that both solutions are likely a response to employer clients seeking increased care access points for their covered workers.

One of the announcements comes from UnitedHealth Group, which in January rolled out a virtual behavioral health coaching program that’s available to UnitedHealthcare commercial plan members with mild depression, stress and anxiety. Through the Optum-administered program, 5 million eligible fully insured plan members can access support “through digital modules and 1:1 video or telephonic conferencing and messaging with trained coaches” at no additional cost. Self-insured employers may also purchase the virtual behavioral health coaching program for their employees, UnitedHealth said.

Elevance Health, Inc. on Jan. 23 announced a deal to acquire Blue Cross and Blue Shield of Louisiana, breaking what one analyst called a nearly two-decade “ice age” in which no major consolidation among Blues took place. Experts say it’s unclear whether the tie-up is a harbinger of a flurry of similar dealmaking, but they suggest that the time may be right to see additional mergers and acquisitions (M&A) among Blues affiliates.

“It has been a long drought” since Blues plans conducted major M&A, observes Ashraf Shehata, national sector lead for health care and life sciences at KPMG. And during that time, the country’s largest health plans have gotten larger and more diversified. “So I think…it’s probably time for the industry, especially on the Blue side, to consolidate a bit more,” Shehata tells AIS Health, a division of MMIT.

Amid heightened demand for mental health care, Medicaid managed care plans are struggling to connect their members with behavioral health care services. New research from the Kaiser Family Foundation (KFF) reveals that low payment rates, along with administrative burden and slow revenue cycles, are key reasons why Medicaid beneficiaries can’t access mental health care despite high need.

The Consolidated Appropriations Act, 2023 (2023 CAA) — the latest edition of the annual bill that funds the federal government — includes notable new policies that will touch on telehealth, behavioral health and Medicaid enrollment, among other areas. According to policy experts, because of the law, health plans have a great deal of new compliance requirements to manage in plan year 2023 and beyond.

Congress discussed notable reforms to telehealth and mental health care over the course of 2022, and the 2023 CAA includes permanent changes to the latter — and temporary extensions of pandemic-era policies for the former. Meanwhile, the law sets out requirements for states and managed care organizations disenrolling Medicaid members as part of the return of Medicaid eligibility redeterminations.

In remarks at a Dec. 13 Brookings Institution event, HHS Secretary Xavier Becerra touted the rollout of the 988 mental health assistance line and the Biden administration’s push for more mental health funding. In addition to promoting the administration’s victories, Becerra also reiterated the urgent need to recruit and retain burnt out practitioners. And he called on Congress to make pandemic-related emergency telehealth flexibilities permanent.

The relatively low amount of available mental health care providers, particularly for youth and in rural areas, is a stubborn barrier to care that has frustrated health insurers that need to meet network adequacy requirements.

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.