Mental health parity –a three-stage path to equality

Mental health parity is a big deal. As I wrote recently (Will mental health parity accelerate adoption of evidence based medicine?) I think the implementation of mental health parity will ultimately lead to greater use of evidence based medicine in general –not just in mental health. But that’s the third stage. The first stage is insurers trying to pre-emptively control mental health costs through circa 1992 managed care tactics such as forcing providers to run an extensive prior authorization gauntlet. The second stage is providers successfully breaking through, and forcing insurers to place no more scrutiny on mental health services than they place on services for physical conditions. The truth is many services in physical medicine are not evidence based and under mental health parity insurers can’t give providers a hard time about evidence based medicine in mental health while giving cardiologists, oncologists, etc. a free pass. Only when insurers lose the second round will they try a more unified cost-control approach.

A letter to the editor from a psychologist in today’s Globe –disputing the Globe‘s editorial that said “alarm among mental health advocates” is premature– lays out the situation well:

My own experience… has made it clear that “patient management tools’’ have indeed become “an excuse for insurers to game the system and lower costs at the expense of necessary treatment for patients.’’

…[I]t is not true that the GIC is targeting only out-of-network providers in making more stringent demands to prove medical necessity. Since last autumn many of us who are in-plan providers have experienced this. UBH says its average clinical phone review is only eight minutes. That has not been our experience.

Getting only eight more visits for a patient in acute suicidal crisis required 90 minutes of preparation for nearly an hour on the phone, not to mention the inordinate invasion of my patient’s privacy.

Physical medicine would not tolerate this for patients with renal failure, but we see many patients with emotional problems that are just as chronic and life threatening.

Stay tuned. We’re still in stage one.

June 4, 2010

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