New Patient Survey Shows Significant Disparities in Access Between Mental Health and Substance Use Versus Physical Health Care

WASHINGTON – Members of the Path Forward for Mental Health and Substance Use issue urgent recommendations in response to new report on continued behavioral health access challenges.

The Path Forward – a multi-stakeholder, national-local coalition to advance evidence-based, data-driven practices and policies with the best chances of increasing equitable access to quality mental health and substance use care – today issued a series of urgent recommendations to expand access to mental health and substance use care in the face of a growing national public health crisis.

The recommendations come in response to a new report of consumer health care experiences released today by The Bowman Family Foundation, which documented that people seeking care for mental health and substance use disorders continue to experience pervasive access challenges and out-of-network provider usage.  

The new data released in the report, Equitable Access to Mental Health and Substance Use Care: An Urgent Need, is based on approximately 2,800 responses to a consumer survey conducted by NORC.

The report found:

• More than half of respondents (57%) who sought mental health or substance use care were unable to access any care on at least one occasion between January 2019 and April 2022.
• Of respondents in employer-sponsored health plans, 39% reported using at least one out-of-network provider for mental health or substance use outpatient care, compared to just 15% for other health care.
• Of respondents in employer-sponsored health plans reporting out-of-network provider use, 80% reported using out-of-network mental health or substance use providers “all of the time” versus only 6% for other health care.

Recommendations to Increase Access 

In response to these sobering findings, the Path Forward makes four recommendations that all stakeholders – payers, providers, regulators, and legislators – should immediately adopt:

1. Expand mental health and substance use networks 

Add mental health and substance use providers of all levels of care to commercial, Medicaid and Medicare networks; fast-track credentialing and other network admis­sion requirements; increase reimbursement rates wherever shortages of in-network mental health and substance use providers exist; and decrease unpaid hours of work by reducing administrative burdens such as pre-authorizations and retrospective claims audits.

2. Integrate mental health services into primary care using clinically effective and resource efficient methods

While there are several evidence-based methods of integrating mental health and substance use care into primary care, the Collaborative Care Model (CoCM) is the “gold standard” approach supported by evidence from more than 80 randomized controlled trials and proven to substantially improve mental health and sub­stance use clinical outcomes in a primary care setting. 

To expand availability of CoCM to all Americans, Path Forward member organizations are working with stakeholders to:

• support policy efforts to ensure all states turn on the Medicaid codes for CoCM (currently only 24 states have done so);
• encourage state Medicaid agencies to pay – at a minimum – Medicare rates for CoCM; 
• increase commercial reimbursement for CoCM codes;
• aim to eliminate or reduce patient out-of-pocket expenses for CoCM in commercial, Medicare, and Medicaid plans; and
• provide training and financial support to enable primary care practices to implement CoCM.

3. Continue covering and paying for video and phone call mental health services 

Purchasers should con­tinue paying for in-person and tele-behavioral health visits, innovations that were proven out during the COVID-19 pandemic. While tele-behavioral services can’t replace all types of care and some people prefer in-person care, the evidence shows that tele-behavioral services can improve access and reduce costs, particularly for under-resourced and rural communities. 

4. Fully comply with and enforce federal and state parity laws 

The volume of evidence showing disparities between access to mental health and substance use care versus physical health care from this Survey and prior studies underscores the importance of enforcing federal and state parity laws and publishing compliance guidance for employers. 

About the Path Forward 

The Path Forward is a multi-stakeholder, national-local coalition to advance the evidence-based, data-driven practices and policies with the best chances of increasing equitable access to quality mental health and substance use care. Path Forward partners include: American Health Policy Institute, American Psychiatric Association, American Psychiatric Association Foundation, The Bowman Family Foundation, The Goodness Web, HR Policy Association, The Jed Foundation, Meadows Mental Health Policy Institute, and the National Alliance of Healthcare Purchaser Coalitions. Learn more: pathforwardcoalition.org

For interviews of the author and organizational participants, please contact Lauren Green at [email protected] or (202) 288-9534.