Nearly all big employers offer mental health benefits. Few know if they work.
Nearly all large U.S. employers offer mental health benefits, but fewer than half know whether their coverage actually works — leaving millions of workers struggling to get effective care despite having insurance, according to two new national surveys.
National mental health coalition Path Forward is calling for companies to get out ahead of workers’ mental health care needs, as employees and employers both say coverage often lacks transparency, accountability and quality controls.
The findings highlight a growing accountability gap as employers invest billions in mental health benefits without measuring results, even though an estimated 165 million Americans rely on mental health care and large employers report that effective use of benefits improves the bottom line, the surveys found.
Path Forward worked with the Employee Benefit Research Institute, a survey of some 3,100 U.S. workers and an employer survey that polled about 400 large companies.
The employee survey found workers with mental health conditions are twice as likely as those without to report unmet health care needs, so many who have insurance coverage still struggle to get effective treatment, Path Forward said in its analysis.
Respondents with mental health conditions were also 50% more likely than those without to use emergency care, the survey showed.
Beyond mental health care, employees who said someone on their plan had a mental health condition also found it more difficult to find specialists and to access prescriptions, indicating they had more trouble navigating other parts of the health care system. Those who did not have anyone with a mental health condition responded they had a harder time finding a primary care physician.
Options are not missing, however, according to Path Forward’s employer survey.
But, while nearly all large employers surveyed offer mental health benefits, fewer than half really know whether the coverage is effective, the survey said. More than half fail to adequately collect or review data on utilization, network adequacy or health plan quality performance.
“The gap here is all about accountability,” Path Forward Executive Director Anna Bobb said in an interview. “Employers really are a major player, but change doesn’t happen just by offering up the resources.”
Locally, Cheryl Larson, president & CEO of the Midwest Business Group on Health, said companies are working on getting more proactive.
“Employers recognize that supporting mental health is essential to having a healthy, productive workforce and have made great strides in recent years to expand coverage and reduce stigma. But coverage alone isn’t enough,” Larson said in a statement. “At MBGH, we’re seeing more employers take a proactive stance, taking steps to integrate mental health into their overall well-being strategies, training managers to spot signs of distress and fostering cultures that normalize help-seeking. The momentum is there, but continued collaboration and data-sharing will be key to turning good intentions into measurable outcomes.”
The Midwest Business Group on Health is a member of the National Alliance of Healthcare Purchaser Coalitions, a founding member of Path Forward.
Bobb said that rather than just checking the box on coverage, employers need to take a more active role to ensure those who need it most are getting mental health care. Among the specific issues employers should keep a closer eye on are appointment wait times, provider availability and whether the coverage follows mental health best practices.
Bobb said employer efforts at improving — not just offering — mental health care have impacted other areas, including cardiac care, and HR departments can set their sights on mental health care coverage, too.
“The health care return on investment and business case, just from intervening earlier on mental health, include higher ‘presentism’ and productivity,” she said.
The coalition — made up of groups like the National Alliance of Healthcare Purchaser Coalitions, the National Alliance on Mental Illness and the National Council for Mental Wellbeing — is working on engaging large employers on improvements that would:
• Expand accountability systems, tracking and encouraging employee use of mental health care;
• Promote earlier intervention;
• Require better data from health plans and third-party administrators; and
• Close the gap between mental health and substance use treatment coverage.
“These surveys show what so many of us already know, that workers are taking initiative to get care, but the system isn’t always meeting them halfway,” National Alliance of Healthcare Purchaser Coalitions President and CEO Shawn Gremminger said in the statement. “Fixing that is not only a moral imperative, but a business one.”
Gremminger’s own coalition reported earlier this year that 70% of employers it surveyed are implementing improvements like integrating behavioral health into primary care, establishing vendor accountability and evaluating/promoting cultural competency and diversity.
This article has been updated to correct the Midwest Business Group on Health’s relationship with the National Alliance of Healthcare Purchaser Coalitions.