Highmark seeks holistic solution in an integration of behavioral and medical health

July 20--Behavioral health care is still provided under a "separate and unequal" system, eight years after enactment of a federal law that meant to curb such disparity, Patrick Kennedy told a group of Pittsburgh-area health insurance caseworkers Tuesday.

But that may start to change by fall when employer compliance monitoring is expected to begin for the Mental Health Parity and Addiction Equity Act, the 49-year-old former Rhode Island congressman told about 20 case managers at Highmark Health. A task force could be formed to do the monitoring.

The law mandates comparable coverage for physical health, substance abuse, addiction and other behavioral health problems for some insurance plans, taking on the opioid abuse problem that has spread nationwide.

"It's shocking that our response to this epidemic has been so anemic," Mr. Kennedy said. People with substance abuse problems are "alien to our affections; they are castaways in society; they are disregarded."

Mr. Kennedy -- the son of the late Massachusetts Sen. Ted Kennedy, and a recovering alcoholic and drug abuser -- was recently appointed to the board of New York City-based Quartet Health Inc., a 2-year-old startup that integrates behavioral health and primary care medicine by giving doctors easy access to psychiatrists, psychotherapists and other caregivers.

Pittsburgh-based Highmark partnered with Quartet in May to expand behavioral health care options to its members while aiming to shrink the overall tab for health care.

Adding behavioral health services was expected to add four-tenths of 1 percent to health insurance premiums or $25.4 billion over a 10-year period, federal estimates showed.

But integration of behavioral and medical health could save between $26.3 billion and $48.3 billion annually in health care costs, with the biggest share of savings coming from people who were commercially insured, according to a second study, which was done in 2014 for the American Psychiatric Association.

Overuse of services, including such things as frequent hospital emergency room visits, can be driven by untreated behavioral health issues, Mr. Kennedy said.

Congress passed the Mental Health Parity Act in 1996, then tightened regulations in the Mental Health Parity and Addiction Equity Act of 2008, which Mr. Kennedy shepherded through Congress.

Quartet, founded in 2014, employs 90 people and raised $40 million in April from GV, formerly called Google Ventures. Quartet CEO Arun Gupta declined to say whether the company was profitable.

In comparison to physical health insurance, coverage for mental health care and substance abuse problems has generally included higher cost-sharing, more restrictive limits on inpatient days and outpatient visits, and separate annual and lifetime caps, a 2015 Robert Wood Johnson Foundation study found. Despite the state and federal laws passed in recent years to end inequities, disparities persist because of patchwork enforcement.

Mr. Kennedy was upbeat, saying a renaissance was at hand as employers and insurers learn about the cost-saving value of behavioral health coverage.

"The business model isn't there yet. This is going to take time," he said. "Let's find the value so it makes sense for insurance companies."

Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699

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