As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This is a reprint of a blog post from KBGH:
You probably know someone like Juanita. Juanita feels so anxious at her job as a delivery driver that she is starting to miss work and perform poorly. She goes to her primary care doctor, who prescribes a medication to help reduce her anxiety and tells Juanita it will take two to three weeks to feel a benefit. Juanita asks if anyone like a counselor or therapist is available to see in the meantime, while she’s waiting for the medication to work. Her doc tells her that the clinic has no behavioral health providers on-site. Furthermore, unbeknownst to Juanita, her insurance policy doesn’t cover therapy sessions very well, and tele-behavioral health may not be covered at all. Juanita decides to seek out a mental health provider on her own. She calls several offices, but because of increased recent demand for mental health services, no one has an appointment available in the next three weeks. Juanita ends up on a waiting list and eventually has a good, albeit expensive, experience at her first visit and feels better. When she asks her primary care doctor and her therapist how much better she should expect to feel after her second visit, though, they can’t give a straightforward answer. They tell her this kind of improvement is hard to measure. They are, however, very careful to screen her for risk of suicide or self-harm.
Marcus works at a different company with a different philosophy toward mental health. When he begins to feel so anxious at his job as a warehouse supervisor that he worries his performance is suffering, he visits his primary care doctor, who prescribes a medication to help reduce his anxiety. His doctor tells him it will take two to three weeks to feel better, just as Juanita’s doctor did. But at his first visit, the doctor rates Marcus’s anxiety with an instrument called the Hamilton Anxiety Scale. He also schedules Marcus for a next-day visit with a licensed specialist clinical social worker (LSCSW) who the clinic contracts with to do tele-behavioral health consults, one of several options in Marcus’s network. The doctor tells Marcus that the LSCSW will work with him on “strength-based” strategies to take advantage of Marcus’s natural skills and talents as a starting point to address his anxiety. Marcus’s benefits package covers the LSCSW’s services just as it would cover any other medical treatment. After two months of visits with the LSCSW and careful medical management by his doctor, who is in frequent contact with the LSCSW, Marcus’s score on the Hamilton Anxiety Scale has declined from an initial score of 24 to a persistent score of 8, indicating likely remission of his anxiety.
The contrast between these two patients’ experiences are obvious in a high-level, qualitative sense. But they have very specific differences: Marcus was cared for in a network with an adequate number of providers, all of whom are in collaborative practice with Marcus’s primary care doctor. Telemedicine under Marcus’s employee plan is covered at the same reimbursement level as in-person visits, and behavioral health is reimbursed at the same rates as other medical care. And Marcus’s doctor and social worker objectively measured Marcus’s state of mental health in order to judge whether or not he was getting better.
These five characteristics–network adequacy, coverage of telehealth, payor parity, measurement-based care, and collaborative care between medical and mental health providers–are but a few of the marks of good access to mental health care. But they are the specific domains that the Kansas Business Group on Health is attempting to improve here in Kansas through a project with the National Alliance of Healthcare Purchaser Coalitions called the Path Forward. We’ve touched on this topic in past blog posts specifically regarding substance abuse. But since we’ve found ourselves in the teeth of a viral pandemic that is probably going to get worse before it gets better, we thought it was important to reinforce what we’re working on around mental health. The scope of this pandemic is not only physical in nature, but also impacts our mental health. There are resources available that KBGH can help you with for you or your employees. If you have specific questions, please reach out to us. We have a number of resources available. We do not know how long the effects of this virus will last, but we know that the impact is far reaching.
