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How health insurance impacts the treatment of substance use and mental disorders

Posted on 04-16-15 in Addiction, Addiction Treatment, Mental Health

How health insurance impacts the treatment of substance use and mental disorders

Historically, health insurance providers have treated mental health and substance abuse differently than other physical maladies and diseases. Prior to 2010, most insurance companies limited the number visits and the types of treatment for mental afflictions, relegating them to the status of an unwanted stepchild. This sorting and segregation only added to the stigma of mental health disorders.

In 2008, Congress and President George Bush passed the Mental Health Parity and Addiction Equity Act (MHPAEA), penned by Paul Wellstone and Pete Domenici, into law.  This bill introduced the new landscape of the healthcare industry, which would create parity between medical benefits and mental health and substance use disorders, no longer allowing insurance companies to treat these categories of care differently from one another.

In 2010, the MHPAEA was fully implemented utilizing the final revisions of the bill. With the passage of the Affordable Care Act (ACA) also known as Obamacare in 2012, the healthcare industry with regards to mental health and substance abuse disorders was transformed even further starting in 2014.

“This will affect the 113 million Americans who had previously faced unfair mental health coverage restrictions,” said CEO Norman B. Anderson, Ph.D., of the American Psychiatric Association (APA).

By defining care for substance abuse and mental health disorders as an essential health benefit, the ACA will integrate these areas into primary health care. Medical providers will be trained, starting at the medical school level, on how to approach these diseases with the same protocols of screening detection and preventative care as any other ailment or disease.

According to the National Institute of Mental Health, more than 57 million Americans suffer from a mental health disorder. Prior to the passage of the MHPAEA, and later the ACA, 25 percent of U.S. citizens did not have adequate access to mental health services, and 44 percent had no mental health coverage. In 2006, a survey from the Substance Abuse and Mental Health Services Administration reported that 49 percent of the adult population who suffer from both serious mental health disorders and a substance use disorder received no treatment at all.

Substance abuse treatment has historically reached only a fraction of the people with the disorder. According to the National Survey on Drug Use and Health, about 20 million Americans would benefit from treatment who previously received no care. Now, all health insurance plans are required to consider and treat substance use disorders as one of the essential health benefits specified by the ACA.

The shift to early detection of mental health and substance use disorders will take time. The intent is to help people with the disorders before they escalate to more serious levels. By emphasizing early detection at the primary care level, treatments for such conditions can improve outcomes and save money. Reducing overall healthcare costs is a central theme of this transformation of care focusing on early intervention.

Recent studies have shown definite cost savings as a result of health professionals receiving extra medical training in substance abuse treatment. In one such study, called the CareOregon Case Study, after tracking cost savings following special training for primary care staff members, the return on investment was $12.21 for every one dollar spent on training.

By addressing substance use and mental health disorders at the primary care level, a major shift in treatment will occur. With the implementation of the MHPAEA and the ACA, people soon will have better trained medical providers and more treatment options available.

Sovereign Health Group is a residential treatment program for substance and mental health disorders with facilities across the nation. For more information about our effective and individualized treatment programs, please call 866-524-5504.