Behavioral health may be an employer’s best investment, as timely access to such care can be pivotal for boosting employee productivity and lowering total cost of care. Blue Cross and Blue Shield of Minnesota is intently focused on ensuring convenient and affordable access to behavioral healthcare across the need spectrum, regardless of age, sex, racial background, geography, or economic status.
One in five U.S. adults experience mental illness every year, but only half receive treatment.1 Barriers to care include:
- Cost: A significant proportion of those facing serious mental illness with unmet needs reported not receiving care in the past year due to reasons related to cost. 46% reported that they could not afford the cost of treatment, and 19% reported that their health insurance did not pay enough for mental health services.2
- Distance: 80% of Minnesota counties qualify as mental health shortage areas,3 requiring members to drive long distances to see a behavioral health provider.
- Stigma: Six in ten adults (62%) say stigma or shame associated with mental health is a “big problem” when considering care.4 Concerns include confidentiality and negative opinions from friends and colleagues.2
- Provider shortage: While the incidence of mental health conditions is growing, the number of behavioral health providers is not keeping pace. More than 150 million people live in federally designated mental health service shortage areas. Within a few years, the country will have a shortfall of between 14,280 and 31,109 psychiatrists — and psychologists, social workers and others will be overextended as well, experts say.5
Behavioral health needs and barriers are especially significant for young people. A national emergency in child and adolescent mental health was declared in 2021.6 While 15% of youth experienced a major depressive episode during the past year, nearly one in three go without treatment, even in states with good access to care.7 Over the last 10 years, the proportion of pediatric emergency room visits for mental health reasons has doubled, including a five-fold increase in suicide-related visits.8 Due to lack of programs and providers, a child behavioral health appointment can involve a wait time of six to 12 months.
Behavioral health impact on employee productivity, cost of care
Employers and benefit administrators are taking notice as behavioral health has a direct impact on employee productivity and total cost of care. Behavioral health is estimated to drive 57% of total healthcare costs.9 Globally, an estimated 12 billion working days are lost every year due to depression and anxiety, at a cost of $1 trillion per year in lost productivity.10 In addition, total costs were 20% higher for patients that have diabetes, hypertension and depression ($27,511) than those with diabetes and hypertension alone ($22,929),11 further demonstrating impact of a behavioral health condition accompanying a physical health issue.
To achieve a healthier workforce and drive down healthcare costs, Blue Cross is expanding access to behavioral healthcare for all employers and members. The first step is to increase the size and reach of our provider network, making behavioral healthcare available where and when members need help. To that end, Blue Cross nationally has expanded its mental health network by 55% over the past five years.12
“Conveners” expand provider network, access to care
A novel approach is to leverage “conveners,” also known as managed service organizations or MSOs, to build out the network and make it easier for providers to work with Blue Cross. Conveners like Rula, Grow, and Headway bring together independent therapists and some psychiatrists to create a high-quality network. They ease administrative burdens on providers by handling contracting, credentialing, billing, eligibility, scheduling and more.
For members, these new options expand access to providers in the Blue Cross network, enable easy online scheduling, increase equity of therapist offerings across demographics — including ethnicity and geographies — and help members find therapists who align with their personal preferences.
Conveners also enable providers to participate in value-based contracts that reward quality of care and patient outcomes, rather than patient volume under a fee-for-service payment model. Although value-based care results in lower cost and better outcomes, it’s used in only 22% of behavioral health contracts.13 Blue Cross is transitioning more providers and care delivery to value-based models.
Behavioral health specialty treatment
Specialty care is another priority for behavioral health network expansion. Specialty areas include:
- Children and young adults: Blue Cross is expanding options beyond traditional inpatient or outpatient settings, offering virtual intensive outpatient treatment with flexible scheduling, often within 24 hours of referral. The program combines personalized care with peer connection to foster long-term healing. Prompt access to care, without distant travel and long wait times, will be critical in addressing the current youth mental health crisis.
- Eating disorders: Traditional models for eating disorder treatment often require members to travel long distances — even out of state — to high-cost residential treatment programs with lengthy stays. Blue Cross has introduced a virtual model that enables people to attend work or school and live at home while obtaining nationally recognized treatment to help them break the cycle of eating disorders.
- Substance use: High-quality substance use treatment can be hard to find and often requires time away from home and work. Blue Cross offers virtual substance use options as a cost-effective and convenient alternative to residential programs. Virtual treatment for substance use is a convenient model allowing members to stay in their community, remain active at work, and still receive the personalized care they need.
Peer support and virtual care expand access
To further expand access to behavioral healthcare, Blue Cross is rolling out creative peer support solutions. Peer support specialists serve as extenders of behavioral healthcare, addressing low-acuity needs that don’t require costly clinical interventions. Peer specialists are proven to help reduce stigma and improve health outcomes — better quality of life and lower rates of relapse — and often are preferred by members.14 Blue Cross and Blue Shield of Minnesota was the first plan in the state to cover peer support for commercial members. It is offered as a zero-cost, in-network benefit.
Behavioral healthcare is shifting to virtual settings as many members opt for the convenience and privacy of therapy through their phone or home computer. Virtual care is especially important to rural communities because it enables access to care without the barrier of transportation. In fact, one-third of behavioral health visits during the past year were delivered via telehealth, more than any other area of healthcare.11
While virtual care is a lifeline in rural communities, expanding access to in-person care remains important. Geography should not be a barrier to accessing mental and behavioral health services. The Mankato State University Rural Behavioral Health Clinic made possible by Blue Cross, is an example of our commitment establish quality, affordable access to care in rural communities. The clinic is scheduled to open in late 2024.
The Clinic and Blue Cross are working together to expand access to face-to-face and virtual behavioral health care services, including prompt access to care for children. Other programs will include peer specialists, community education and screening events. In addition to serving as a community-based outpatient mental health center, the clinic will act as an academic training center to educate the next generation of clinicians who will meet the access needs of individuals in the future. This is the first training clinic of its kind.
Through forward-looking provider alliances and focus on member needs, Blue Cross is expanding access to behavioral healthcare. When employees and their families get the care they need, employers benefit from a productive, motivated workforce with reduced absenteeism and lower medical costs. Leveraging our clinical outcomes and cost data, Blue Cross aims to continually deliver innovative behavioral healthcare solutions that expand access while lowering the total cost of care.