Employer medical claims likely miss 75% of employee mental health issues

Health insurance companies, self-funded employers, and the health care community cannot detect all cases of mental illness. (Photo: Shutterstock)

We inferred that we had a mental health epidemic in the United States before the pandemic. And employer medical claims likely miss more than 75% of employee mental health issues. Our mental health epidemic begins long before people are adults.

For reference, prior to the February 2019 pandemic, the University of Michigan reported that approximately one in seven adolescents and children “has at least one treatable mental health condition, including depression, anxiety or ADHD”.

Related: A New Framework: Mental Health Benefits in the Post-Pandemic Workplace

The report further cited that half of these children did not need treatment from a mental health professional in 2016, according to the University of Michigan study published in JAMA Pediatrics. After the pandemic, a JAMA Network The article of a “meta-analysis of 29 studies involving 80,879 young people worldwide” found that clinically elevated depression in children and adolescents was 25.2% and anxiety 20.5% . He noted that during COVID-19, the prevalence of depression and anxiety symptoms doubled compared to pre-pandemic estimates.

Additionally, the epidemic of mental illness appears to be spreading into adulthood. According to 2020 data reported by the National Institute of Mental Health, “one in five American adults lives with a mental illness (52.9 million in 2020). Mental illnesses include many different conditions that vary in severity from mild to moderate to severe.

Other data from the National Institute of Mental Health defines any mental illness (AMI) as “a mental, behavioral or emotional disorder. AMI can have a variable impact, ranging from no impairment to mild, moderate and even severe impairment. »

  • In 2019, an estimated 51.5 million American adults age 18 and older had an AMI, which equates to 20.6% of all American adults. Women had a prevalence rate of 24.5% compared to 16.3% for men
  • By age, the prevalence rate of AMI was 29.4% for adults aged 18 to 25, 25.0% for those aged 26 to 49, and 14.1% for those aged 50 and over. more.
  • The prevalence of AMI was 31.7% among adults reporting two or more races, followed by white adults at 22.2% and Asian adults at 14.4%)

That said, at the Health Transformation Alliance (HTA), our medical claims data shows an increase in claims related to anxiety (+19.6%) and depression (+7.4%) from 2019 to 2021 Additionally, medical claims related to anxiety increased (+7.5%), and depression increased (+5.4%) from 2020 to 2021.

While we at the HTA are experiencing an increase in mental health claims, the number of claims is relatively low. For anxiety, in 2021 the HTA saw 43.5 reported complaints per 1,000 people or 4.35%; and reported claims for depression were 39.6 per 1,000 or 3.96%.

Ultimately, medical claims are vastly underreported compared to reported mental health rates. In fact, rising medical claims only indicate that the problem is more widespread. But health insurance companies, self-funded employers, and the health care community cannot detect all cases of mental illness.

Uncaptured claims include patients paying for services in cash at a doctor’s office and employee assistance programs, where reports are spotty or non-existent. Additionally, 45% of Americans with mental health issues at the clinical level do not seek care, according to the Million Mental Health Project launched by Sapien Labs. Reasons for not seeking help from individuals included:

  • A preference for self-help (36%)
  • A lack of knowledge of what kind of help to seek or where to get it (34%)
  • Lack of confidence in mental health treatment (28%), including respondents who thought it would not help (19%) and feared being forced into medication or hospitalization (13%)
  • 22% did not seek help due to stigma/fear of people knowing
  • 17% did not act due to a lack of resources

In the United States, according to the Kaiser Health Foundation, as of 2020, nearly 164 million Americans received health insurance through their employer. If 20.6% of Americans suffer from any mental illness, this indicates that 33,729,162 people with employer coverage suffer from AMI. Most are not captured in the data but, more importantly, are not processed by the individual or the employer.

This adds to an epidemic of mental illness long before the pandemic. So how can employers address this issue to ensure their employees are happy and efficient? Also, how can employers help these working parents meet the mental health needs of their children?

The answers are neither obvious nor easy. But the next generation Employee Assistance Programs can and do make a difference by giving employees a pathway to help. These programs, such as Lyra or Spring Health, provide employees with same-day access to mental health services with a coach or therapist.

As reported by the American Psychiatric Association, Center for Workplace Mental Health, EAPs go beyond mental health. While they can help with emotional and addiction issues and interpersonal relationships, they can extend to legal issues and financial difficulties. It is important to note that EAP services are generally provided free of charge to the employee on a limited basis.

Additionally, the US government pushes the issue via the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). In the 2022 report, he highlighted the epidemic by citing that “recent data from the Centers for Disease Control and Prevention indicates that between August 2020 and February 2021, the percentage of adults with symptoms of anxiety or disorder depression increased significantly, from 36.4 percent to 41.5 percent.

The MHPAEA is designed to ensure equal and increasing access to mental health and substance use disorder coverage.

Employers can lead the way by ensuring employees have access, ongoing reminders, and open sessions to encourage employees to reach out. Some employers offer unlimited use of the EAP to help patients get the help they need. Others offer special programs to target the causes of widespread stress, such as special programs to prevent burnout, seminars on managing racial stress, and webinars on managing substance use/abuse disorders. substances.

The bottom line is that few employees are likely to medically treat mental health issues through their employer-sponsored health care plans. Additionally, data shows that there is still a stigma with mental health issues being swept under the rug. The inference that employer medical claims likely miss 75% of employee mental health issues is just one data point that underscores that mental health may be an epidemic in America.

Lee Lewis is Director of Strategy and GM Medical Solutions at Alliance for Health Transformation.


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