The employer’s role in championing mental health

To begin, we’re taking you back to middle school science class. The central nervous system, which is made up of the brain and spinal cord, is the processing center that regulates every function of the human body. The brain, the most vital organ in the body, is the controller of all other organ functionality and how we sense, feel, learn, make decisions, and solve problems, and more. Mental health disorders are those that affect a person’s mood, thinking and behavior; and a major cause of these disorders is rooted in physical impairments within someone’s brain anatomy and or chemistry.

To oversimplify for emphasis, everyone at your organization has a brain (except any AI personalities you may be working with). Over 20% of people are diagnosed with mental health disorders, with many who go undiagnosed and untreated. With the potential to impact every employee in your population, there is a critical need to address mental health in your workforce.

By having access to mental health resources through their organization, employees can prevent and treat mental health disorders and improve their overall health and vitality. This can contribute to increased job satisfaction and productivity, and a psychologically safe work environment promotes and increases utilization of invaluable health care services. So, what can you do at your organization to foster a culture that values and encourages mental health care?

Enhancing accessibility to mental health services

Even within the most forward-thinking organizations, accessibility can represent an incredible challenge. Across the United States, a common complaint fielded by human resource and total rewards professionals is a lack of health care accessibility for mental health and substance use disorders.

For employees who are insured through their employer health plan, oftentimes mental health services fall outside of coverage. The Kaiser Family Foundations 2022 Women’s Health Survey reported that around 1/3 of women surveyed had to wait over a month to receive care. 20% of them indicated that their provider did not accept their insurance.

This points to a systemic issue: why would these providers not accept insurance? Employees looking to utilize their employer-sponsored health insurance seek in-network or participating providers by looking at their carrier provider directory. The shocking discovery as of late is that many times, these provider directories-- now being referred to as “ghost networks”--are inaccurate, outdated, and display unavailable providers.

According to The Miliman Research report, U.S. psychiatrists are paid an average of 20% less than primary care physicians using the same or equivalent billing codes. To put it frankly, providers receiving inadequate pay for their services results in them leaving the insurance network and a dent in accessibility. In fact, a 2018 study revealed that more than half of the counties in the U.S. did not have a practicing psychiatrist.

This represents a massive shortfall in healthcare. If an employee is actively seeking care, they are recognizing the need for help internally and have taken action. This also comes with an underlying current of optimism that their employer will support them throughout their wellbeing journey. The moment that experience becomes challenging, they may abandon receiving treatment altogether. The care pathway from initial search to ongoing treatment is one that should be examined and continually improved from a Total Rewards standpoint.

What are your options as an employer?

It’s important to understand these issues at their foundation. Ghost networks are something that can be fully vetted and potentially remedied in an organization’s request for proposal (RFP) response. Higher pressure by employers can force insurance carriers to invest in solutions and thus eradicate these issues. Ask insurance carriers what tools and solutions they deploy to address ghost networks and lack of access to mental health providers, and how they are working to comply with the No Suprises Act.

Important accessibility considerations for employers:

• Employee footprint: Identify where there are access issues in your medical insurance network via disruption reporting and geo-access reporting.
• Network and contractual limitations: Understanding that in many cases, mental health providers do not accept contractual reimbursement rates provided by insurance companies. Ask for out of network claims reporting to identify where employees are struggling to find in-network care.

To alleviate these accessibility problems, employers can consider a third-party mental health solution that lives outside your health insurance program. Some solutions that live in this space such as United We Care, Lyra Health, and First Stop health fill health plan gaps.

In addition to facilitating in-person care, offering a virtual behavioral health solution establishes employee accessibility to prescribing physicians and therapy resources. Employers should also consider absorbing or subsidizing the cost of these virtual solutions.

Key policies to consider implementing to enhance mental well-being in the workforce

Policies foster culture.

Pharmacy Benefit Management

A study conducted by Centers for Disease Control and Prevention (CDC) from 2019-2021 defined mental health treatment as taking prescription medication for feelings of anxiety, depression, assistance with any other emotions, concentration, behavior, or mental health. 23.2% of adults aged 18-44 and 21.2% of those aged 45-64 received treatment.

By collaborating with medical insurers and pharmacy benefit managers (PBM), employers can gather valuable data on the prevalence of mental health treatment needs within their workforce. By understanding how many subscribers are undergoing treatment and which pharmacy classes they live in, strategies to reduce barriers to treatment can be implemented.

Changes to prescription drug benefits to consider:

• Absorbing or further subsidizing employee costs associated with filling behavioral health prescriptions.
• Offering a program that provides manufacturer's coupons for relevant medications.
• Revamping benefit communication materials to include highly specific member responsibility and access information for behavioral health prescriptions.

Also consider that your PBM and any additional point solutions need to be compliant with prescription laws in all states your employees reside and should be evaluated for this compliance component.

Other Policies to Consider

1. Robust absence and leave program: A comprehensive absence and leave program is essential for supporting employees through challenging times. By offering paid or subsidized leave during crises, mental health medical treatment, and bereavement, employers can demonstrate their commitment to their employees' well-being. This policy ensures that employees have the necessary time and resources to address their mental health needs and recover from difficult situations. 
2. Substance abuse care policies: Substance abuse is one of the top sources of mental illness in the United States, as identified by the CDC. Employers can collaborate with their medical insurer to ensure accessibility to substance abuse programming is available across all channels. This includes network analysis and geo-access reporting. Additionally, by incorporating substance abuse coverage into policies like disability and critical illness plans, employees are more financial supported to seek care.
3. Financial health programs: Recognizing the impact of financial stress on mental health, employers should consider implementing programs that promote financial well-being. Initiatives such as financial coaching, retirement accounts, life insurance and long-term care insurance can help alleviate financial burdens and provide employees with long-term stability. 
   1.  Financial benefits, like accident, critical illness, hospital indemnity, and pet insurance can bridge the gap during financially stressful events, reducing anxiety and promoting peace of mind.
   2. Lifestyle accounts funded by employers offer the opportunity for employees to pursue lifestyle and well-being enhancements that are meaningful to them.
   3. Medical deductible and copay financing programs.
4. Well-being programs: Employers should consider a range of well-being programs to address the diverse needs of their employees. 
   1. Employee resource groups can provide belonging, support, motivation, and psychological safety for employee subsets who may experience feelings of isolation and burnout. 
   2. Physical well-being initiatives: Exercise programs, free preventive health screenings, nutrition counseling, weight management solutions, and gym discounts directly impact employees' physical health, which is closely linked to mental well-being.
   3. Strategic wellness program planning: Employers should consider multi-year strategic initiatives that are multi-faceted. MMA East helps clients develop and implement such initiatives through our Well-being Your Way solution, which addresses financial, social, physical, and mental health.
5. Family and caregiver benefits
   1. Consider adding in paid fertility benefits within medical coverage or implementing a third-party solution for Fertility coverage.
   2. Parental leave is a critical component of any robust leave program. Culturally, employers should seek to support all employees who pursue building a family, that includes maternal, paternal, and adoptive, by alleviating their stress and financial burden of time off work. 
   3. Caregiver advocacy programs that can help explain programs like Medicare and long-term care.
   4. Dependent care savings accounts: Pre-tax benefit accounts that enable employees to pay for eligible dependent care expenses such as childcare, summer camps, and adult day programs.

Creating a culture of mental well-being requires a comprehensive approach that encompasses various policies, programs, and perhaps most importantly execution with socialization. Employees value and take pride in working for companies that destigmatize seeking mental health care. Access to substantial resources can help them feel supported and contribute to increased job satisfaction and productivity.

How can Marsh McLennan Agency help?

We can help your organization develop and implement strategies that support mental well-being among your workforce. Our team can work with you on optimizing your mental health care strategy via our dedicated pharmacy practice, proprietary network analytics tools, benefit program diagnostic assessments, vendor evaluation and so much more. If you have questions on any of these concepts or how you may want to drive impact in these areas of your organization, Contact us today.