Q&A: Fighting for mental health parity in healthcare using data, part two

In part two of our two-part series, Patrick J. Kennedy, former U.S. Representative and founder of The Kennedy Forum, and Nawal Roy, CEO and founder of global behavioral health data platform Holmusk, discuss with MobiHealthNews how coverage for mental health has changed since the signing of the parity act and what steps the partners are taking to help lawmakers draft even more effective bills to progress mental healthcare coverage. 

MobiHealthNews: Mr. Kennedy, since the Mental Health Parity and Addiction Equity Act became law, how have you seen insurance coverage for behavioral health change?

Patrick J. Kennedy: Yeah, so we’re dealing with a legacy of discrimination for a long, long time where mental health has been carved out. It has been marginalized. People were charged higher co-pays, higher deductibles, higher premiums and they were really subjected to lower lifetime caps for coverage. All of those things we eliminated when we passed the parity law. 

And what we also did was say that you couldn’t impose any higher medical management decision thresholds for gaining access to mental health and addiction then you would otherwise see in medical management for other medical services. 

That has been harder to manage in terms of its enforcement, largely because regulators are not equipped to really hold insurance companies accountable because they have big departments, and they can shower regulators with these massive amounts of data and check all these boxes and there’s no way to validate and verify. That’s changing under new proposals that have been put out.

There will be a greater burden of proof on the part of payers to do a lot of that analysis and demonstrate their, you know, fidelity to parity through the paperwork that they submit. We’ve made more progress in some states than others because they have a stronger regulatory infrastructure. California, New York, Massachusetts and Pennsylvania have had much stronger enforcement of their state parity laws. 

We obviously are very concerned about the Wit Decision in Northern California because it has broader implications about whether payers must follow generally accepted standards of care, medical standards of care, or whether insurance companies can often continue to develop their own criteria for making those decisions on what level of care you get, how long that care is.

Nawal Roy: Let me add to what Patrick just said on two or three points. Point number one is we can certainly learn from other therapeutic areas because the progress in behavioral health has been substandard even after Patrick really lead the signing of the parity act.

The total cost that we as a society are spending is significantly larger than purely on the healthcare expense. And the drivers behind that can be we don’t expect fundamentally insurance companies to change on their own. Either they feel the pressure of the market forces, or the pressure of the litigation, or the pressure of the regulation. So the burden is on us to figure out who is going to be the first moving this. Any insurance company can take this and literally say, I’m going to make the changes and make this as a source of my competitive advantage and start covering it. If that happens, then all of a sudden, other companies will start doing it. The second could be literally a regulation driving and saying no, parity is very important. 

So it is a hardcore sort of social/policy/clinical problem, and at the core of all of it is, if you really want to go into solving the plumbing of it, is all around data. How do we connect the dots through a common language of understanding the data so that we can have this clinical discussion but also can have policy discussions in a very meaningful fashion?

Kennedy: We have to understand, as Nawal said, the distributed cost of not investing in mental health. If we capture the downstream costs of not providing the upfront care, it will be easier for us to justify more upfront care, a greater investment in mental health, but it’s not going to be until we really understand the full impact of untreated mental health on cardiovascular disease, on oncology, on diabetes, then we’re going to be able to justify asking for a much bigger percentage of the premium dollar go into mental health. Power really doesn’t change easily and moving dollars from one section of the healthcare system to another is going to be very difficult. But if the data is clear, that if you want better outcomes for heart disease and diabetes, and so forth, that mental health is the secret sauce that’s going to deliver that then it’ll be easier for us to make that case. 

MHN: What are the next steps?

Kennedy: We are organizing what’s known as the Alignment for Progress, which is a five-year campaign to put forth, for the first time ever, a policy guide that will include all of the mental health diagnoses, all the addiction diagnoses, all behind one policy guide in electronic form that will assist policymakers in writing better policy and lawmakers writing better laws and regulators writing better regulations. We are doing this in collaboration with all of the major stakeholders in mental health and addiction. 

And I have the unique ability to bring them together because parity is uniquely beneficial to all of them. And because of my experience in policy, I can kind of take this on as kind of a quarterback because, frankly, none of the individual stakeholders can necessarily convene the others in the same way that I’m able to convene them. 

And I’m using the 15th anniversary of the parity law being signed by George W. Bush and the 60th anniversary of President Kennedy’s Community Mental Health Act to initiate this campaign. We’re going to release a policy guide that we’ve worked on with some very big stakeholders in this space. And what I’m very excited about is we’re trying to create the equivalent of a chamber of commerce agenda for businesses or an AFL-CIO for labor organizations. We need to create something akin to that for mental health and addiction, where we look at these issues holistically because the same things that help, you know, a person with addiction help people with mental illness and vice versa. We have 98% in common, but we often, unfortunately, advocate within silos. And I really believe that Nawal is going to be a crucial partner with Holmusk for us in the private sector to help inform how data can really influence better decision-making.

And frankly, a lot of other stakeholders are going to benefit from this. I mean, because if we want value-based contracting, we’re going to need to really understand the risk of various populations so that people will invest in the proposition that if we do a better job and build a better mousetrap and get better outcomes, that is worthwhile. We’re only going to be able to do that if we can demonstrate that value can be brought in terms of better outcomes for patients and the lowering of their comorbidities. The lowering of their symptoms, and, in turn, the lowering of the cost not only to insurers but lowering the cost to society. That’s our big holy grail for the long haul.

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