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Highmark's expanded access to high-quality mental health care delivers results

Highmark's expanded access to high-quality mental health care delivers results

A year after launching a mental and behavioral health platform, Highmark is reporting significant improvements in both access to care and member outcomes.
Highmark introduced Mental Well-Being powered by Spring Health in January 2024, now enabling 2.5 million people ages six and up access to mental health care. The tool includes screenings for more than a dozen mental health conditions, the ability to quickly schedule a virtual or in-person appointment with a therapist or psychiatrist and a library of on-demand educational resources.
The collaboration is part of Highmark's ongoing commitment to making mental and behavioral health an equal pillar to medical health, said Doug Henry, a clinical psychologist who serves as medical director for Highmark Health's enterprise behavioral health team. Today, Mental Well-Being is available to members across a wide range of Highmark plans, including commercial fully insured and self-funded, Affordable Care Act, Medicare Advantage and the Pennsylvania Children's Health Insurance Program.
'Mental health is a key part of whole-person health,' Henry said. 'You can never talk about someone's mental health separate from the context of their overall medical health.'
Improving access, outcomes
Just over a year into the collaboration, Spring Health has completed more than 100,000 appointments for Highmark members. The results were incredibly compelling, Henry shared, demonstrating the effectiveness of rapid access to high-quality, low-friction care. Highlights include:
It takes less than two days on average for members to secure a psychiatric or psychotherapy appointment, compared to more than a month in much of the U.S.
People are using mental health services more readily, with 80% of Mental Well-Being users engaging in mental health services for the first time in at least 18 months.
On average, members with moderate to severe anxiety or depression are treated to remission in less than six sessions.
'Mental health treatment can be expensive, so you want to have efficacious care,' Henry said. 'You want to have someone go into treatment where there is a beginning, middle and an end, and then they're better. Mental Well-Being is delivering that for us.'
The benefits extend beyond cost containment, he said. Employees who access timely and effective mental health care are more productive, more engaged and healthier overall. When untreated, mental health challenges can exacerbate physical health issues as well.
'Investing in high-quality, effective mental health services is one of the best ways — and one of the least expensive ways — to lower total cost of care for your employees while improving community health,' Henry said.
How it works
Finding the right therapist is a common challenge for those seeking mental health support. Spring Health uses an AI-driven algorithm to match people to providers who are most likely to meet their needs, considering a host of consumer preferences to ensure a good fit.
'Ninety-six percent of our members who get paired with a Spring Health clinician stay with that clinician for six months or longer or through the course of their treatment,' Henry said. 'That's very unusual in mental health. It's more typical that about 50% of the time the first therapist you meet is not a match.'
In addition, Mental Well-Being goes beyond offering therapy and psychiatric appointments. It includes educational programs, self-guided cognitive behavioral therapy programs for issues such as stress, meditation programs and behavioral health coaching. It also offers medication management, 24/7 crisis support and higher levels of specialized care for substance use disorders, eating disorders and other complex challenges.
Continued growth
Highmark is continuing to invest in expanding mental health services through both the Mental Well-Being program and its network of 44,000 providers, Henry said. The company is closely studying the data to identify which interventions yield the best results and incorporating mental health as part of each person's overall care.
'We believe in delivering the right mental health care, at the right time, tailored to each individual's unique needs and circumstances,' he said. 'And Mental Well-Being is how we're scaling that personalized access to care for our members.'
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Debt and delayed care forecast for some who lose insurance under tax and spending law

time4 hours ago

Debt and delayed care forecast for some who lose insurance under tax and spending law

Delayed treatments, canceled doctor visits, skipped prescriptions. Losing insurance is bad for your health. The Congressional Budget Office forecasts that the U.S. uninsured population will grow by 10 million in 2034, due to the tax and spending bill signed into law by President Donald Trump. And, thanks to a natural experiment nearly two decades ago, researchers can forecast what that will mean for patient care. Among the problems they predict will develop as a direct result of these people losing coverage: — About 2.5 million people may no longer have a personal doctor. — About 1.6 million patients will take on medical debt. — The lack of care may cause nearly 22,000 deaths annually. 'There's really no questioning the basic reality that you can't take health care away from 10 million people without causing many preventable deaths,' said Dr. Adam Gaffney, lead researcher on a team that explored the new law's impact. 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People covered through the Affordable Care Act's individual insurance marketplaces also will see shorter enrollment windows and no more automatic renewals. Gaffney, of Harvard Medical School, and other researchers looked to past studies to measure how many people would experience detrimental effects, like going without prescriptions, from the upcoming changes. Gaffney updated the published analysis, which was originally based on the House version of the bill, at the AP's request. One study in particular was critical for their work: In 2008, Oregon offered a rare opportunity to compare groups of people enrolled in Medicaid with those who were not. After a four-year period of frozen enrollment due to budget limitations, the state determined it could enroll 10,000 more people in Medicaid. It used a lottery system to make the selection amid high demand. That gave researchers a chance to follow people who got coverage and those who did not, similar to how scientists testing a new drug might compare patients taking it to those given a placebo. 'This is a gold standard research design because it replicates a randomized-controlled trial,' said Christine Eibner, a senior economist at RAND Corp. who was not involved in the study. Applying results from that study and other research to the recent CBO estimate allowed Gaffney and other researchers to estimate specific effects of losing coverage. 'By taking coverage away, we are putting patients in a terrible position,' said Gaffney, a former president of Physicians for a National Health Program. Amanda Schlesier went four days without her cancer treatment Calquence this spring and wound up in a local emergency room, delirious with pain. The leukemia patient worries about what might happen if she stops treatment again for a longer stretch because she's lost Medicaid. 'God forbid I forget to fill out a page of documentation, and suddenly I lose access to my medication or my doctors or any of the treatment that I've been going through,' the 33-year-old Farmington Hills, Michigan, resident said. People can still receive care when they don't have coverage, but important steps often are delayed, said Dr. Gwen Nichols, chief medical officer of The Leukemia & Lymphoma Society. Patients may be able to visit a doctor, but they would have to line up coverage or help before they can receive expensive chemotherapy. Diagnosis also may be delayed. Meanwhile, the patient's cancer continues to grow. 'It's a ticking time bomb,' Nichols said. The first thing patients often ditch when they lose coverage are screenings designed to catch health problems before they become serious, said Dr. Jen Brull, president of the American Academy of Family Physicians. That could mean patients skip tests for high cholesterol, which can contribute to heart disease, or colonoscopies that detect cancer. Researchers forecast that a half million fewer women will have gotten a mammogram within the past year by 2034. When patients struggle financially and lose coverage, they focus on things like keeping a place to live and food on their table, said Brull, a Fort Collins, Colorado, physician. 'Seeing a doctor because you don't want to get sick feels like a much lower priority,' Brull said. Patients start taking financial hits at all ends of care when they lose coverage. They may have to pay up front or start a payment plan before they receive care, said Erin Bradshaw, an executive vice president with the nonprofit Patient Advocate Foundation, which helps people with medical bills. Anyone with an outstanding balance will have to pay it before the next appointment. Financial assistance may be available, but patients don't always know about it. Getting help also may take time and require the submission of tax returns, pay stubs or some validation that the patient no longer has coverage. Bradshaw said letters stating that a patient has lost Medicaid sometimes arrive a couple months after the fact. That can contribute to treatment delays or missed medication doses. Some patients also try to avoid financial stress by skipping care. Schlesier said she delayed seeing a doctor when she first felt symptoms of her cancer returning because she had no coverage at the time. If prescriptions are too expensive, patients may simply not get them or split the doses to stretch the medicine. For Thomas Harper, it's a question of priorities. 'Sometimes you have to make a choice, how well do you want to eat this week versus taking your medicine,' he said. The West Monroe, Louisiana, truck driver has around $300 a month in prescriptions as he deals with diabetes and recovers from non-Hodgkin lymphoma, a type of blood cancer. 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