For the first time, health insurance companies’ own data can be used to more accurately pinpoint where increased access to care is needed and payment disparities exist in real-time.
The Mental Health Parity Index key findings for the four largest commercial insurance plans:
- 43 states show disparities in access to in-network mental health care and treatment for substance use disorders relative to physical health.
- Patients in 7 of 10 counties face challenges finding in-network clinicians for mental health care and substance use disorder treatment compared to physical health clinicians.
- All states show disparities in payment for treatment of mental health and substance use disorders.
- Across the four national commercial insurance plans assessed, clinicians who provide mental health care and substance use disorder treatment are paid between 16% and 59% difference from physical health clinicians nationwide.
- On average, the four national insurance plans provide in-network access from 24% to 83% difference for physical health clinicians relative to those available in-network for mental health care and substance use disorder treatment.
A new tool unveiled today provides the first look at real-time commercial insurance data on mental health and substance use coverage metrics. The Mental Health Parity Index raises the potential of widespread issues for patient access and clinician pay, which can mean longer wait times, higher out-of-pocket costs, and increased reliance on out-of-network care for individuals seeking treatment. The Index was launched by The Kennedy Forum in collaboration with Third Horizon, the American Medical Association (AMA), the American Psychological Foundation, and Ballmer Group.
The Index aligns with what many families experience on a regular basis. The release of the national Mental Health Parity Index makes accessible data that may help explain why commercially insured Americans face widespread access gaps to mental health and substance use care relative to physical health services:
- In 43 states, enrollees in plans offered by the nation’s four largest commercial health insurance companies face potential disparities in finding in-network mental health care and substance use disorder treatment relative to physical health care.
- Locally, 7 in 10 counties face similar issues, potentially making it harder for patients to find in-network mental health care or substance use disorder treatment where they live.
When benchmarked to Medicare payment rates, the majority of clinicians providing mental health and substance use disorder treatment are paid less than clinicians providing physical health treatment, potentially driving lower clinician participation in insurance networks.
- Across the nation’s four largest commercial health insurers, all 50 states have lower payment levels for outpatient mental health care and substance use disorder treatment than for outpatient physical health care.
- On average, mental health care and substance use disorder treatment is paid between 16% to 59% difference from physical health care nationwide for the four major insurance networks analyzed.
While no insurance company achieves comparable parity metrics nationwide, some commercial networks were found to meet or exceed parity metrics in select states or counties. The data opens an opportunity for an informed and targeted conversation about why metrics differ across the plans and geographies. By visualizing, for the first time, how insurance contract data relate to potential disparities on the ground, the Index helps insurers, employers, providers, consumers, and policymakers better understand where access problems are greatest. Addressing the potential access and pay gaps tackles one of the biggest issues facing care, which should be paired with steps toward improving the quality of the care that people have access to. It can also highlight best practices among insurers that can be shared more widely.
“Mental health parity is about one simple promise: that mental health and addiction care are treated the same as any other medical care,” said Patrick J. Kennedy, co-founder of The Kennedy Forum and co-author of the Mental Health Parity and Addiction Equity Act of 2008. “The Mental Health Parity Index makes it impossible to ignore where we stand and offers a powerful opportunity to intentionally shape how we track and deliver treatment, building on work The Kennedy Forum has advanced to promote measurement-based care and new payment models that reward quality. This is a breakthrough moment to expand our vision — from what’s necessary to what’s possible — to give people the care they deserve no matter where they live.”
“As the Mental Health Parity Index expands nationally, it gives health plans, employers, policymakers, and providers a clearer view of where parity breaks down in practice,” said Greg Williams, President of Third Horizon. “For the first time, stakeholders can see plan-specific detail across geographies and use that transparency to strengthen each network, improve access for individuals and families, and provide stakeholders the data needed to take cost-saving and life-saving action.”
“Patients deserve the same access to mental health and substance-use disorder services as they do for any other medical condition—it’s that simple,” said AMA President Bobby Mukkamala, MD. “Strong federal and state laws require affordable and accessible in-network mental health and substance-use disorder services, but patients still have to fight insurers to get it. The Index demonstrates that many health insurance companies can improve networks for patients and payment for clinicians. These data highlight where payers and policymakers can work together on concrete solutions so patients can get the care they need and overall care quality can improve.”
“As a psychologist, I’ve seen how easily wellbeing falls to the bottom of our ‘to-do’ lists, but I’ve also seen how systemic barriers can make care feel out of reach. Looking at real insurer data reveals a deeply concerning issue — widespread gaps in coverage that affect both the people seeking care and the clinicians striving to provide it. Transparency is a powerful first step in advancing parity across the nation while at the same time empowering providers and consumers to demand accountability. We must build a system that truly prioritizes mental health as essential healthcare, not simply an optional benefit,” said Michelle Quist Ryder, PhD, CEO of APF.
Transparency for Action
Currently, states can work with the groups behind The Mental Health Parity Index to conduct deep-dives into their state’s parity landscape. Illinois — which signed a mental health parity bill into law shortly after the Index was piloted — is the first to undertake this work. With support from the New York Community Trust, New York State will also examine in-depth metrics for data affecting its 11 million commercially insured citizens.
To explore the Mental Health Parity Index, click here. For more information about the national expansion or how you can use the tool, contact info@thekennedyforum.org.
