Health Care Law Offers Wider Benefits for Treating Mental Illness

Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all.

This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases.

Now comes the Affordable Care Act combining parity with the individual mandate for health insurance. As Dr. Dilip V. Jeste, president of the American Psychiatric Association, told me, “This law has the potential to change the course of life for psychiatric patients for the better, and in that sense it is both humane and right.”

To get a sense of the magnitude of the potential benefit, consider that about half of Americans will experience a major psychiatric or substance disorder at some point, according to an authoritative 2005 survey. Yet because of the stigma surrounding mental illness, poor access to care and inadequate insurance coverage, only a fraction of those with mental illness receive treatment.

For example, surveys show that only about 50 percent of Americans with a mood disorder had psychiatric treatment in the past year — leaving the rest at high risk of suicide, to say nothing of the high cost to society in absenteeism and lost productivity. The World Health Organization ranks major depression as the world’s leading cause of disability.

One of the health care act’s pillars is to forbid the exclusion of people with pre-existing illness from medical coverage. By definition, a vast majority of adult Americans with a mental illness have a pre-existing disorder. Half of all serious psychiatric illnesses — including major depression, anxiety disorders and substance abuse — start by 14 years of age, and three-fourths are present by 25, according to the National Comorbidity Survey. These people have specifically been denied medical coverage by most commercial insurance companies — until now.

From an epidemiologic and public health perspective, the provision that young people can remain on their parents’ insurance until they turn 26 is a no-brainer: By this age, the bulk of psychiatric illness has already developed, and there is solid evidence that we can positively change the course of psychiatric illness by early treatment.

Mental disorders are chronic lifelong diseases, characterized by remission and relapse for those who respond to treatment, or persistent symptoms for those who do not. In schizophrenia, for example, relapse is common, even with the best treatment. It makes no sense to tell someone with this condition that his lifetime mental health benefit is just 60 days of inpatient hospitalization.

Psychiatric illness is treatable, but it is rarely curable; it may remit for a while, but it doesn’t go away. That is why the current limits on treatment are as irrational as they are cruel — the discriminatory hallmark of commercial medical insurance.

No more. The Affordable Care Act treats psychiatric illness like any other and removes obstacles to fair and rational treatment.

Older people with mental illness will also benefit, because the law will eventually fill in the notorious gap in Medicare drug coverage known as the “doughnut hole.” The law will immediately require drug companies to give a 50 percent discount on brand-name drugs and then gradually provide subsidies until the gap closes in 2020.

On the other hand, poor people with mental illness still have cause for concern. The new law would have expanded Medicaid to insure 17 million more Americans, but the Supreme Court ruled that states could decline to accept this expansion without losing their existing Medicaid funds. In states that opt out of the Medicaid expansion, poor people with mental illness may find themselves in a terrible predicament: They earn too much to qualify for Medicaid, yet not enough to get the federal subsidy to pay for insurance.

But on the whole, the Affordable Care Act is reason to cheer. Americans with mental illness finally have the prize that has eluded patients and clinicians for decades: the recognition that psychiatric illness should be on a par with all other medical disorders, and the near-universal mandate to make that happen.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

View the original article here

Priority Health Offers Targeted Wellness Packages

An estimated 40 percent of health care costs in the U.S. are avoidable, according to a Thomson Reuters study. One of the most effective ways to cut these costs is through workplace wellness programs. Priority Health is furthering its commitment to health, wellness and empowerment through a set of customizable packages designed to help employers develop and sustain a culture of health and wellness, leading to lower health care costs.

“Our focus has always been on improving health — for individuals and organizations alike — and through these wellness packages, we can continue to proactively make a difference,” said Joan Budden, chief marketing officer for Priority Health. “By providing wellness packages we know to be effective, and allowing for customization, employers can target their vital needs to not only improve health, but also help control costs and increase employee productivity.”

The three Priority Health wellness packages are built on comprehensive data integration — claims history, biometric screenings, health risk appraisals and survey results combined with Priority Health’s expert analysis and predictive modeling capabilities — and are targeted for each employer to gain meaningful results. The packages help promote employee engagement by helping employees better understand their wellness needs and possible health risks, and through access to tools that spur positive lifestyle changes.

The Core wellness package includes a company-specific Web page; health risk appraisal surveys to analyze employee health status and provide information about workforce wellness; tools and best-practice tips needed to recruit workplace advocates who can help get a program under way; a monthly wellness e-newsletter; and quarterly reports to evaluate the program’s progress. The package also offers an in-depth analysis of health risks, significant investment opportunities, and a report with strategy plans and specific recommendations to further improve health and wellness.

The Advanced package comprises everything in the Core package, and also offers on-site biometric screenings that measure employees’ cholesterol, glucose, body mass index and blood pressure. It targets high-risk health coaching to help employees establish and achieve realistic goals, and offers a group lifestyle-change program to help implement multi-week challenges and group activities, along with goal-focused on-site classes taught by health and fitness professionals. The package also offers year-to-year ROI reporting.

The Ultimate package takes any wellness plan to the next level by administering a reward program. Priority Health will help put a plan in place to give employees positive reinforcement for engaging in wellness activities and accomplishing their wellness goals. It also offers year-to-year ROI analysis to track the effectiveness of the program.

The Priority Health wellness programs are the first in Michigan and one of only 20 organizations nationwide to receive the National Committee for Quality Assurance Wellness & Health Promotion Accreditation. Wellness programs are evaluated in key areas of health promotion, including how wellness programs are implemented in the workplace, how services such as health coaching are provided to help eligible individuals develop skills to make healthy choices, and how sensitive health information of eligible individuals is properly safeguarded.

About Priority Health

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. The company offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 620,000 people and continues to be rated among the best health plans in the nation by the National Committee for Quality Assurance.

View the original article here