Ensure health plans meet workers' needs
When employers purchase health insurance or third-party administrator services for health care, they are buying a product with a profound effect on workforce well-being and productivity. Yet, they often have no idea of the quality of what they are buying in terms of mental health networks and access to care. A recent survey indicated that one-third of employers recognize that their health plan’s network did not have enough providers for employees to get the timely access they need.
More transparency and accountability would allow employers to make better choices among their insurance options, and their employees would benefit from quicker access to care, broader networks, less out-of-pocket costs, and better user experience. To realize these gains, employers must require and analyze useful data and have their HR team test the navigation systems and user experience. Given the impact on employee well-being and productivity, it is critical for employers to take an active role in holding insurance companies and third-party administrators accountable. In addition, it will assist employers in ensuring a provider’s compliance with parity laws.
Consider the following activities:
- Conduct a routine comprehensive review of services, including vetting providers for quality and real-time availability to determine the best benefit options for workers.
- Map mental health care providers with the workforce’s geographic footprint to ensure a specified number of providers are in-network and within a specified distance from workers’ home addresses.
- Regularly monitor and report benefit utilization rates, behavioral health claims, employees’ experiences with services, standard wait times, and barriers to accessing care.
- Request feedback on workers’ experiences accessing mental health benefits by administering surveys or reviewing provider complaints.
- Collaborate with external partners and community organizations to assess and improve workers’ access to mental health care.
- Offer a health advocate, human resources coordinator, or concierge service that assists workers in navigating their health care and benefit options, such as scheduling an appointment with a provider on a worker’s behalf, verifying insurance coverage with the provider, and addressing billing questions or issues.
- Conduct secret shopper calls to determine if the health insurance plans meet the organization’s standards for care and better understand the worker’s experience in accessing care.
- Ensure parity between medical and mental health service coverage by requesting the following data:
- Actual participation rates by mental health and substance use disorder (MH/SUD) providers listed in health plans’ directory
- Denial rates for MH/SUD services versus medical/surgical (M/S) services
- In-network reimbursement rates for MH/SUD providers versus M/S services
- The use of out-of-network providers for MH/SUD care versus M/S care
These quantitative measures evaluate MH/SUD network adequacy as outlined in the Model Date Request Form (MDRF) by the National Alliance of Healthcare Purchaser Coalitions and the HR Policy Association. Learn more about the MDRF.
Employers that cannot offer traditional health insurance can support workers’ health care needs by providing paid sick leave and mental health days, promoting to employees free community-based mental health resources, increasing compensation or providing a stipend to subsidize marketplace health insurance options, and contributing to health savings or reimbursement accounts. See “Workplace Mental Health Solutions for Small Employers” for more suggestions.