Voice of the Purchaser Survey on Behavioral Health Report
National Alliance, in partnership with HR Policy Association and in conjunction with the Path Forward, conducted a survey to understand the perceived importance and performance of services received from behavioral health service providers, including health plans. The survey gauged concerns and views of employers around the following:
- Equitable Access
- Quality of Care
- Integration of Behavioral Health into Primary Care
- Workplace Mental Health Support
The survey, including key purchaser expectations, was developed via an iterative process through feedback and insights from employers, coalitions, the Path Forward Steering Committee, and others.
Survey responses were then collected from February to March 2023 using the online survey platform Qualtrics. Respondents could select up to five service providers to evaluate performance and had the option for each provider to indicate whether any specific requirement was out-of-scope or if they did not know how to evaluate (those responses were not included in the results). Respondents were also asked to provide qualitative comments on up to three key delighters and dissatisfiers for each provider.
The survey was distributed through National Alliance coalition members and the HR Policy Association resulting in a convenience sampling of 221 private and public employers from a variety of industries providing coverage for more than 10 million people across the country.
General attitudinal statements and importance ratings were evaluated overall (not at the service provider level). The performance results at the health plan/vendor level were only based on responses where employers chose to rate that dimension for that service provider. Average service provider ratings were only included where there were five or more ratings to a question.
- While 99% agreed that effective and timely access to in-network behavioral health providers is important, only 31% were satisfied; 31% expressed dissatisfaction with efforts to systematically identify and address gaps in network access; and 33%
expressed dissatisfaction with efforts to help facilitate access for members having problems accessing timely behavioral health services
• Tele-behavioral health services were important to 95% of employers and 65% were satisfied with these services
• Only 34% of employers agreed that their behavioral health directories accurately reflect the providers available to plan participants, and 26% indicated dissatisfaction that their plan provides a directory that accurately reflects in-network behavioral health providers.
• 84% of employers agreed that behavioral health access and quality are as important as the financial management of behavioral health costs
Quality of care
- While 54% were satisfied with the promotion of standardized measurement for behavioral health services, only 33% were satisfied with engagement and reporting of behavioral health outcomes
- Monitoring appropriate prescribing of behavioral health medications relative to patient outcomes was important to 94% of employers and 41% indicated being satisfied with performance in this regard
- 43% of employers were satisfied that their service providers administered denials that were clinically justified and sensitive to patient needs
Integration of behavioral health into primary care
- 84% agreed that it was important that plans support, promote and incentivize integration of behavioral health into primary care, but only 28% were satisfied
- 64% agreed that early identification through broad use of behavioral health screenings can mitigate the severity of mental health issues
Workplace mental health support
- Achieving high engagement in workplace behavioral health programs was important to 92%, but only 39% were satisfied
- Providing behavioral health awareness and stigma reduction programs was important to 89% and 40% were satisfied that their vendors were meeting these needs
Health equity and whole-person health
- Only 27% of employers were satisfied that their service providers evaluate and tailor behavioral health services to diverse communities (e.g. LGBTQ+, People of Color)
- Only 14% of employers were satisfied with service provider support of whole-person program integration through data and process coordination