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Behavioral healthcare currently exists in a unique historical moment. Healthcare costs continue to rise, and spending is growing faster than the average annual growth rate in the last decade.
Simultaneously, there is a growing demand for behavioral healthcare, making it the “bipartisan issue of our time” with broad bipartisan support in Congress.
Historically, affordability and behavioral health access issues have been viewed as conflicting. The rise in healthcare costs often led to restricted access to behavioral healthcare as a cost-cutting measure.
However, it’s crucial to recognize that affordability and access are intertwined rather than contradictory. By enhancing access to quality behavioral healthcare, integrating organizational empowerment strategies, and improving the member experience for individuals and their families, affordability can be improved.
What challenges does this approach aim to tackle, and how did we come to believe the myth that affordability and increased access are mutually exclusive?
Affordability and access: the biggest challenges in BH
While rising healthcare costs are not a new issue, the surging demand for access to behavioral healthcare, coinciding with historically high healthcare costs presents a fresh challenge for health plans, employers, and individuals.
Notably, spending on behavioral health services among Americans with private insurance increased significantly by 53% from 2020 to 2022.
Affordability continues to get worse
Despite the growing need for quality behavioral healthcare, there’s a persistent need for improvements in both affordability and access. In the past year:
- 17% of insured adults didn’t receive necessary behavioral healthcare, with 44% citing affordability as the primary barrier
- The gap in out-of-network care utilization for behavioral health benefits compared to physical health benefits surged by 85%
- Insured individuals are over twice as likely to opt for out-of-network care and pay higher fees for behavioral healthcare compared to physical healthcare
Adding to the challenge, health insurance premiums for employer-sponsored plans increased by 7% in the last year, with expectations of further increases next year. This year, individuals, on average, paid $8,435 in premiums, while families faced a substantial $23,968 in premiums for employer-sponsored health insurance.
Ghost networks are rampant, driving barriers to access
Along with affordability challenges, individuals encounter difficulties reaching behavioral health providers or services, and ghost networks are becoming prevalent.
A secret shopper study by a senate committee staff found that more than 80% of listed, in-network behavioral health providers are inaccessible. They either aren't accepting new patients, unreachable, or not in-network as listed. Another study discovered that over half of all mental health providers listed on the Oregon Medicaid managed care providers’ network didn’t see patients.
Almost half of Medicare Advantage online provider directories have at least one inaccuracy, often related to behavioral health services.
Access and affordability are deeply interrelated, especially for employers
During a recent Q3 earnings call, Cigna’s President and CEO David Cordani said, “In addition to affordability, one of the top priorities for many employers is expanding access, coordination, and overall effectiveness of behavioral health programs and solutions.”
Employees are demanding access to robust, high-quality behavioral health benefits from their employers, who in turn are demanding better behavioral health benefits from their health plan providers while voicing concerns about cost.
This puts health plans in a tough spot. They aren’t in a position to stop healthcare inflation and can’t create new behavioral healthcare provider networks out of thin air.
The most impactful myth in behavioral healthcare
The current state of affordability and access has led to the biggest myth in behavioral healthcare—that there’s a choice between better access to behavioral healthcare and health insurance affordability.
The origins of this myth trace back four to five decades. Behavioral healthcare was initially treated as a cost center and largely ignored. Health plans were reluctant to provide coverage. Multiple rounds of congressional legislation addressing mental health parity laws ensued, compelling insurers to cover treatment, with pending parity regulation currently under consideration.
But what if the myth is wrong?
Many health plans have sought to reduce access to behavioral health services as a cost-cutting measure to enhance the affordability of health insurance.
But what if that reasoning is wrong? What if solving access and getting people into high-quality care improves costs for health plans and individuals?
Behavioral health is proven to drive medical spend. Suppose an individual has diabetes, cancer, or a heart condition. In that case, medical spend is two to three times higher for those individuals who also have a behavioral health condition than for individuals without.
A groundbreaking study by Milliman found that a small group of high-cost individuals are responsible for a significant percentage of total healthcare costs. These high-cost individuals were mostly people with behavioral health conditions, and yet many of these individuals had minimal or zero spending on behavioral health-specific services.
Stakeholders are recognizing that behavioral healthcare is not simply a cost driver. It’s integral to people’s health and well-being. Neglecting it results in escalated healthcare costs. There is a path forward where medical spending is reduced, and people get better access to quality behavioral healthcare, mitigating two of the most significant issues in behavioral health.
Busting the myth
Shifting the narrative on this myth involves connecting the dots between better access and affordability, aligning business motives—such as growing revenue and market share for health plans—with the importance of better access to behavioral health for the growing population seeking these services.
Merely broadening access to behavioral healthcare doesn’t address affordability. The missing components are:
- Quality of care, including clinical outcomes
- Patient-provider matching
- Measurement-based care
- Organizational level strategies
- Member experience for individuals and their families
Taking a broader perspective on the approach to behavioral healthcare in the last three decades reveals that implementing these fundamental building blocks—access, quality, member experience, organizational level strategies, and cost reduction—has largely fallen short. For many individuals, the behavioral healthcare experience has been far from satisfactory.
At Spring Health, we think we’ve figured out how to balance these fundamental aspects of care. Let’s explore how we’re doing it.
Spring Health’s approach
In behavioral health, bettering clinical outcomes starts with better access. If someone seeking care has to wait for a prolonged period to meet with a provider, they probably won’t engage in care in the first place.
Organizational strategies are also available to assist health plans in delivering mental health care at scale, with real-time insights, seamless integration, and validated clinical outcomes.
At the same time, it’s also possible to support the well-being of members and their families by streamlining access to care and empowering individuals to find the support they need quickly, safely, and confidently.
So, let’s start by exploring access, and then we’ll cover the other pillars of this framework: quality member experience, organizational strategies, and cost savings.
Access
Elevated access to behavioral health providers goes beyond giving employees a list of providers. Individuals need the ability to make an appointment quickly with a provider who accepts new patients, has a specialty that suits their needs and has matching availability.
Spring Health members have direct access to our entire provider network’s availability within our member platform and can see all of a provider's upcoming time slots, which are updated in real-time.
Our members are also getting:
- Fast access to care, with first therapy appointments available within two days
- Personalized care discovery, including provider matching that utilizes data for precision mental healthcare
- Preventative support
- Well-being resources
Quality member experience for individuals and their families
The Spring Health app, which centralizes all behavioral health scheduling and services into a single front door, has a rating of 4.9 stars out of 5 in the app store. Our providers have a 9.4 out of 10 rating from our member populations.
Here’s a snapshot of what it’s like to access a provider with Spring Health:
- An employee, health plan member, or dependent reaches out for help and accesses the Spring Health member portal. It only takes a few minutes to set up their account and take a short online assessment.
- In a few minutes, they can book their first appointment with a therapist—who they’ve chosen from a diverse provider network—within two days.
- The members’ list of potential providers has been filtered using data from their assessment and inputted into powerful machine learning algorithms to match them with the most suitable provider.
Organizational strategies for health plans and employers
Addressing behavioral health at the individual level is important, but it’s also critical to zoom out and consider strategies at the organizational level.
For example, health plan or workplace leaders might consider integrating a suite of services to help them make informed, data-driven decisions, transform culture, and effectively deliver mental health solutions at scale. This might encompass areas such as:
- Organizational empowerment
- Integrations and referrals
- Compliance and accessibility support
- Integrating a data ecosystem that includes real-time insights and analytics, including for ROI
Cost savings
Connecting members quickly to high-quality care, using measurement-based care and precision mental health, leads to members getting measurably better faster and translates into cost savings through a reduction of overall medical spend.
The Validation Institute, an independent third-party organization, recently found that:
- For every $1.00 invested in Spring Health, customers saved $2.20 on health plan spend. Savings increased to over $4 when accounting for reduced absenteeism and turnover.
- The largest savings were driven by a reduction in physical health spending, especially for people with chronic conditions, including $5,226 in savings for people with diabetes, $5,040 for people with hypertension, and $6,930 for patients with cancer.
- Overall, total health plan spend was lowered by $2,430 per participant within the first six months of engagement.
Learn how to successfully break down barriers to behavioral healthcare for marginalized groups.
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