Managed Care

 

Mental Health Parity Just Around the Corner?

MANAGED CARE April 2008. © MediMedia USA
Editor's Memo

Mental Health Parity Just Around the Corner?

John Marcille
MANAGED CARE April 2008. ©MediMedia USA

John Marcille

Don’t believe it until you see it. Our cover story on mental health parity by Contributing Editor Martin Sipkoff reports that we are at a turning point. The focus is mainly on what legislators will do, but Washington, D.C., is famous for good ideas that never became law.

As Martin notes, there’s a House version that practically no one likes and a Senate version that almost everyone likes. He artfully outlines the pros and cons of each and shows just what employers specifically, and the nation’s health care apparatus generally, would gain in outcomes and savings. He notes that although pharmacy costs did actually go up, “Aetna Behavioral Health demonstrated a total cost savings of $136 per member per month… compared to members who were not enrolled.” This experience and other data show that health plans should welcome the push for parity.

Now, on the matter of the New York attorney general’s attack on plans’ reimbursement of UCR charges. This is not the problem it is made out to be. Health plans just need to restate the formula as a percentage of what the plan pays to an in-network physician or other provider for that service, not tying it to an arbitrary UCR calculation. The plan should always pay outsiders less than it pays network providers, and that difference should be made clear. Why continue a system that is confusing and seems unfair?

Payers should have no trouble with this. Moreover, full transparency here will alert patients to exactly how much the non-network provider is charging. They can easily see why a network provider, in most cases as good as or better than the out-of-network provider, is to be preferred. They can also see that some providers are gouging the patient who has no health plan to negotiate prices for him and the patient who forgoes that advantage by going out of network.

Plans would have been better off, and will be better off, with real transparency.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014