How can we improve mental health services provided by employers?

At the American Psychiatric Association meeting last week, the APAM Center provided some suggestions. AJMC reports that their 5 policy recommendations include:

1. Create action plan to insure network adequacy. “Employers can start by expanding services at the inpatient and outpatient levels, and engaging regional and national organizations to add providers, including specialty providers. They can update provider directories to ensure accuracy and make sure employees can easily find out which ones are accepting new patients. Reimbursement must be adequate; providers should have financial incentives meet access and quality metrics.”
2. Are employers providing coverage for mental health on par with physical health? This question can be answered empirically by checking whether denial of care rates for mental health and substance abuse care are similar to those for physical health services. One can also check whether individuals with mental illness have similar rates of in-network and out-of-network service use as those with physical health. If out-of-network use is high for individuals with mental illness, that may be an indicator that additional investigation is needed to determine if network adequacy is sufficient.
3. Are employers measuring quality of care? The APAM Center recommends that providers capture quantitiative information over time on patient well-being including metrics such as Patient Health Questionnaire (PHQ-9) or the Generalized Anxiety Disorder 7-item scale (GAD-7).
4. Are employers integrating behavioral health with primary care? Teh APAM Center recommends
   Collaborative Care Model (CoCM) promotes the full integration of behavioral health care within the primary care practice. As an economist, I see benefits and costs for these collaborative approaches. While collaboration is healthful so doctors can view a patient more holistically and address multiple issues simultaneously (economies of scope), specialization is also beneficial.
5. Is telepsychiatry the wave of the future? Telepsychiatry offers patients additional privacy and access to specialists located far from their office or home. However, is telepsychiatry as effective as in-person visits? What about the need to coverage digital apps that have demonstrated efficacy?

For employers, providing high-quality mental health coverage should be a top priority. How exactly to reach this goal in a cost-effective manner, however, is not a simple task.