Highmark’s behavioral health partnership looks to lower costs, close gaps

3 strategies to improve hospital cost containment, cash flow

A recent partnership between Highmark and a technology-centric mental health startup aims to improve access to mental healthcare using claims data to target members who would benefit from behavioral health services, according to TribLive.

The Pennsylvania insurer entered into a partnership with New York City-based Quartet Health in June with the goal of reducing ancillary healthcare costs that accumulate for patients who don’t receive necessary mental health treatment. By analyzing claims data, Quartet identifies patients with frequent emergency room visits or inconsistent medication use that might be forgoing necessary behavioral health treatment, according to the article. The company coordinates follow-up care through the patient’s primary care physician or connects beneficiaries to telehealth providers.

The partnership also aims to close the gap in accessing mental health services, an issue that continues to plague the healthcare industry even five years after the passage of the Mental Health Parity and Addiction Equity Act of 2008, which requires insurance plans to cover mental health and substance abuse treatment at the same level as other health conditions.

The relationship between providers and payers isn't always so seamless. Therapists are finding it more difficult to work with insurers because reimbursement rates are less than half the market rate, and providers find it difficult to get accepted into a plan's network, according to Kaiser Health News. Although many insurers have dropped annual limits on therapy and lowered copays, some are still denying coverage through medical necessity reviews. However, America’s Health Insurance Plans has highlighted an increasing number of partnerships between behavioral health organizations and insurers designed to close the gap.

Estimates indicate that more comprehensive mental health care could save as much as $48.3 billion in healthcare costs each year, according to the Pittsburgh Post-Gazette.

In March, the Centers for Medicare & Medicaid Services added new requirements to the mental health parity law that requires Medicaid and the Children’s Health Insurance Program to offer the same coverage as private plans. President Barack Obama also announced the creation of a new task force that will focus on heightened enforcement of the law.   

- read the TribLive article
- here’s the Post-Gazette article 
- see the KHN article