Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 27, Issue 1, 2024. Pages: 23-31
Published Online: 1 March 2024

Copyright © 2024 ICMPE.

PERSPECTIVE
A Path to Value-Based Insurance Design for Mental Health Services

Michael C. Freed,¹* Jennifer L. Humensky,² Patricia A. Areán²

¹PhD, EMT, Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Rockville, MD, USA.
²PhD, Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Rockville, MD, USA

Mental health care affordability is a top treatment seeking barrier.  Questionable care quality further disadvantages people seeking and paying for mental health care.  Aligning costs with expected clinical and functional benefits would incentivize the delivery of high value mental health care.   In turn, ineffective or untested care could still be offered but at costs high enough to offset high value care.  The authors build on Benson and Fendrick’s paper on Value-Based Insurance Design (VBID) for mental health (J Ment Health Policy Econ 2023; 26(3): 101-108) and present a preliminary framework to consider VBID for mental health care.  Using PTSD as an example, key ingredients of VBID for mental health care are identified.  VBID holds promise as an important lever for increasing the delivery of high value mental health care while discouraging low value care.  This paper identifies important research opportunities to make VBID a reality for mental health care.

Background: Aligning cost of mental health care with expected clinical and functional benefits of that care would incentivize the delivery of high value treatments and services. In turn, ineffective or untested care could still be offered but at costs high enough to offset the delivery of high value care.

Aims: The authors comment on Benson and Fendrick’s paper on Value-Based Insurance Design (VBID) for mental health in the September 2023 special issue of this journal. The authors also present a preliminary framework of key ingredients needed to consider VBID for mental health treatments and services.

Methods: The authors briefly review current and past efforts to contain costs and improve quality of mental health care, which include (for example) use of carve-out and carve-in programs, evaluation of cost sharing models, impact of accountable care organizations, and studying other benefit designs and impact of federal and state policies.

Results: Using PTSD as an example, key ingredients of VBID for mental health services were identified and include the following: tools for case identification and monitoring progress over time at the population level; specific treatments and services with evidence of clinical effectiveness, cost-effectiveness, and health equity; and an approach to document the specific treatment or service was delivered (versus another treatment or service that may lack evidence).

Discussion: The inability to afford mental health care is a top barrier to treatment seeking. People who do elect to spend time and money on mental health care are further disadvantaged by accessing care that is not well regulated and the quality at best is questionable. VBID could be an important lever for increasing access to and use of high value mental health care. Partnerships among the research, practice, and policy communities can help ensure research solutions meet needs of these two communities.

Implications for Health Care: VBID holds promise to make high value mental health care more affordable while discouraging low value treatments and services.

Implications for Health Policies: While evidence gaps remain, these gaps can be filled concurrently with pursuit of VBID for mental health services.

Implications for Future Research: This paper identifies important research opportunities to help make VBID a reality for mental health care.