California’s experience with Parity since the year 2000 provides a glimpse into many of the potential pitfalls as well as a handful of thoughtful recommendations for greater success in implementation. The California experience reveals that, above all, communication to consumers and providers is critical. What was learned in California and other states is of tremendous value to plans all over the country scrambling to implement the Mental Health Parity and Addiction Equity Act of 2008 in the coming weeks and months. There is an opportunity to learn from the experience of others that shouldn’t be missed.
Researchers at Mathematica Policy Research and SAMHSA conducted a study of the California experience with Parity and found:
- Failure to properly communicate Parity in mental health and addiction treatment resulted in nearly 50% of Californians polled being completely unaware of the law. Public education campaigns have a positive impact on the reduction of stigma and increase the satisfaction of consumers, family members and providers alike.
- Failure to communicate Parity’s impact on plans and policies results in discontinuity of care and disruptions in treatment.
- Government oversight is important where cost controls, quality and access are concerned. Health plans and managed care are overseen at the state level by departments and commissioners of insurance who will need to know what to look for in order to provide a greater service to their constituents.
- The actual costs of Parity were less than the 2% projected increase.
- Plans can expect concerns and issues with their definition and application of “Medical Necessity” in authorizing care and coverage
- Complaints were common among consumers who were provided lists and networks of providers who, in fact, weren’t accepting new patients. Plans must take the time to evaluate actual access measures and not simply accept what their networks and managed behavioral healthcare organization carve-out vendors tell them. Due diligence is key.
- The list of diagnoses and conditions covered under the law was often found to be arbitrary by both providers and health plans. Providers admit to diagnosing patients in such a way as to obtain the greatest coverage.
“Lessons learned” for plans and employers from the California experience boil down to the following:
- Communicate your new mental health and addiction treatment plan policies in a friendly fashion early and often.
- Communicate all changes to plan members AND providers.
- Focus on quality, access and costs. A narrow focus on costs is misguided.
- Don’t expect strict and narrow constraints on covered diagnoses to save your plan money.
- Be prepared to share your medical necessity and level of care guidelines with consumers and providers
- Properly assess and evaluate “carve-out” contracts and vendors. A crave-out is not slam-dunk solution.
Patrick Gauthier, Senior Consultant, Managed Behavioral Healthcare, is a subject matter expert in behavioral health information systems and data management, quality improvement, as well as social marketing.
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