A new tool developed by the American Medical Association, The Kennedy Forum and Third Horizon is shedding light on longstanding disparities in access and payment for mental health and substance use disorder, according to an Aug. 20 AMA report.
Here are six things to know:
- The tool is called the Mental Health Parity Index. It’s an interactive, open-access tool that analyzes payer data to compare access, network participation and reimbursement for mental and physical health services. It was built using CMS’ Transparency in Coverage data and was piloted in Illinois, though developers are hoping to roll out the tool nationally.
- Mental health providers are paid less. The tool found that physicians treating mental health and substance use conditions were reimbursed approximately 27% less than those providing physical healthcare.
- Network participation is lower for mental health. In Iroquois County, Ill., 73.2% of physical health providers were in network compared to 34.5% of mental health providers.
- Inpatient reimbursement trends reveal an imbalance between mental and physical health admissions. On average, per-day payments for inpatient mental health admissions are nearly double those for physical health admissions, the tool found.
- The tool highlights disparities among counties. The index uses color-coded heatmaps to illustrate access and payment gaps by county and insurer, offering a granular view for policymakers and health advocates.
- Health plans are failing patients. Health plans often deny coverage for physician-recommended care, worsening patient health and contributing to preventable emergency visits and hospitalization, Jesse Ehrenfeld, MD, the AMA’s past president said. “It’s exacerbating this crisis in our communities,” Dr. Ehrenfeld said.
