While 20% of the U.S. population is impacted by behavioral health issues, very few seek treatment. This is in large part due to the lack of insurance coverage for these services. Members are not getting the treatment they need, when they need it.
Behavioral health concerns are often treated as separate from physical ailments. While physical concerns may be outwardly obvious, behavioral health issues can easily be hidden. Members struggling with these issues may appear to be healthy. However, insurers and payers must look at health as not merely the ostensible absence of disease. The WHO’s definition of health is “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”
Neglecting to address behavioral health issues early on can translate into serious health problems down the line, as well as escalated costs for insurers and providers.
Why insurers don’t cover behavioral health treatments
Behavioral health treatment is complicated. From a preventive standpoint, there isn’t always a clear line pointing to underlying health issues or the impact they could have on overall health.
How lack of behavioral health coverage harms members
With the shortage of services and lack of coverage, members aren’t getting care when they need it. Members in need of behavioral health services are the least likely to be able to advocate for themselves. They require an extra line of support, as they don’t often have the ability to recognize the need for care. They are also more likely to live alone or to lack human interaction. Without the proper care, they are more likely to visit a provider only when it is an emergency situation. Without a support system, the prognosis for their recovery is grim.
Why behavioral health belongs in primary care
When delivered effectively, primary care is whole person care. This includes behavioral health. It cannot be treated as a separate issue from physical health.
There has been some progress in the integration of behavioral health into member care. 50% of small firms and 84% of large firms are now offering behavioral or lifestyle coaching programs, according to the KFF 2019 Employer Health Benefits Survey.
Managing high-cost claims, including those behavioral health related, are at the top of large firms’ healthcare priorities, according to the results of the NGHB Large Employer Changes for 2020 Survey. Primary care is the best way to treat the underlying issues, and reduce costs.
Why insurers should care
Easy access to quality behavioral healthcare is beneficial to insurers. Members whose behavioral health issues are addressed are more likely to be successful in managing their physical health as well. Healthy members translates into a more robust, productive workforce. Costs are reduced for insurers when members are holistically healthy.