Understanding the Mental Health Parity Act: A Guide for Providers (From Payer Executives)

Value Based Care Advisory (VBCA) Podcast

This podcast episode dives deep into the complexities of mental health parity and the implications of the Mental Health Parity Act. The conversation emphasizes the necessity for behavioral health services to be treated with the same level of care and coverage as physical health services, addressing the ongoing disparities in treatment and reimbursement practices.

Alex Yarijanian and Dr. Chris Esguerra discuss the challenges providers face when navigating insurance plans and the barriers to accessing equitable care for patients.

Dr. Esguerra is board certified in both Psychiatry and Health Care and Quality Management and is a Fellow of the American Psychiatric Association and the American Board of Quality Assurance and Utilization Review Physicians.

Dr. Esguerra’s extensive payer-side executive experience includes:

• Senior Medical Director, Blue Shield of California
• Senior Medical Director, Magellan Health
• Deputy Chief Medical Officer, Health Plan Of San Mateo

They highlight the critical role employers play in advocating for better mental health coverage and how they can leverage their purchasing power to ensure compliance with parity laws. Ultimately, the episode aims to empower providers with the knowledge and tools necessary to advocate effectively for their patients and promote a more integrated and equitable healthcare system.

A significant focus of the episode is on the role of providers in identifying and addressing parity violations. The speakers guide listeners through the necessary steps for raising concerns regarding unequal treatment, emphasizing the importance of gathering evidence and understanding insurance policies.

This segment is particularly valuable for behavioral health providers who may face obstacles in securing appropriate coverage for their patients. The discussion also touches upon the regulatory landscape, explaining how self-insured plans differ from traditional insurance plans and the implications this has for parity enforcement.

Additionally, the episode discusses the importance of employers in advocating for better mental health coverage, encouraging providers to leverage their relationships with these entities to push for systemic changes that prioritize mental health equity.

Takeaways:

• The Mental Health Parity Act requires equal coverage for both physical and behavioral health services, ensuring that patients receive the same level of care.
• Providers should gather evidence of parity violations and present it to state regulators to advocate for fair treatment.
• Behavioral health is lagging behind primary care in integration and reimbursement models, highlighting the need for systemic reform.
• Employers play a crucial role in advocating for mental health parity by demanding better coverage from their insurance plans.
• Effective communication and partnerships between providers and health plans can lead to better patient outcomes and innovative care models.
• Tracking outcomes and demonstrating quality of care is essential for providers to negotiate better contracts with health plans.

Companies mentioned in this episode:

• Blue Shield of California
• Magellan
• Kaiser Permanente
• Google
• Apple
• Anthem
• Centene
• United
• Cigna
• Aetna
• Humana
• CalPERS
• Pacific Business Group on Health
• National Business Group on Health

Chris Esguerra MD MBA