Patrick Kennedy, son of the late Sen. Ted Kennedy, co-sponsored the 2008 Mental Health Parity and Addiction Equity Act while serving as a Democratic congressman from Rhode Island. In 2013, he founded the not-for-profit Kennedy Forum to support parity in health insurance coverage for behavioral and addiction treatment and advance evidence-based practices. Kennedy, who wrote a 2015 memoir about his and his family’s struggles with mental illness and addiction, currently is pushing regulators and large employers to crack down on insurers that discriminate against people who need behavioral care. Kennedy recently spoke with Modern Healthcare senior reporter Harris Meyer. The following is an edited transcript.
MH: Why did you launch the Kennedy Forum?
Kennedy: No one has really advocated for people with mental illnesses. The patients have no voice themselves, and their families rarely want to go public, or else they’re overburdened. Politically, there’s very little public pressure to enforce regulations and strengthen statutory authority.
MH: Why did you focus on establishing parity in coverage between behavioral care and physical care?
Kennedy: I see parity as the medical civil rights act for people with brain illness. It’s a unifier. Are you treating these diseases like any other disease? If you aren’t, nothing can make up for that.
MH: What is the Kennedy Forum doing to advance coverage parity?
Kennedy: We started ParityTrack.org to develop a 50-state scorecard on statutory laws, regulations and processes, and case law. In October, we and other groups released a scorecard that assigned failing grades to 32 states.
Now we have ParityRegistry.org, a system to track parity complaints. It’s also a guide for people to file appeals against insurers that wrongly deny coverage. We don’t want state legislators to think that just because they voted for a parity law, that’s enough. We want them to vote for fair housing, recovery supports, good coverage laws and strong enforcement.
MH: What will be the impact, if any, of the federal class-action ruling in March that found United Behavioral Health, the nation’s largest behavioral health insurer, breached its fiduciary duty under the Employee Retirement Income Security Act? The judge said United used unreasonable and overly restrictive guidelines to make coverage decisions for tens of thousands of mental health and substance abuse patients?
Kennedy: It’s a huge deal. It’s a textbook case of everything we’re talking about. It shows United, for its own financial gain, came up with its own medical management criteria that had no relationship to commonly held medical standards. Advocates have been waiting for the smoking gun, and they got it.
MH: How is your organization following up on the ruling, which likely will be appealed?
Kennedy: We sent letters to state regulators, congressional leaders and the Fortune 100 companies to remind everyone that insurers and employer health plans have a fiduciary responsibility under ERISA to comply with the federal parity law. I’ve talked to the governors of Illinois, Rhode Island and Connecticut, and they are starting to conduct market reviews of United’s practices and policies. United just ruined it for themselves and all their colleagues. The onus will be on insurers now.
MH: What else is the Kennedy Forum doing on parity enforcement?
Kennedy: The parity registry has more than 1,000 complaints around the country. In the wake of the United decision and other enforcement actions, we’ll get more and more people feeling like they want to fight back and have their voices heard. We can assist people if they file lawsuits. If health plans are falling short on parity, we’ll have data to show there’s a pattern there. That will help policymakers, lawmakers, and attorneys general. We have to assume other insurers are operating the way United did.
MH: What are the challenges you see for patients and their families in getting high-quality behavioral health and addiction treatment?
Kennedy: Right now patients are finding providers through ads on TV and the internet, and that’s a failure for both patients and insurers. Payers haven’t focused enough on this issue to drive care to the evidence-based models we know work. Why haven’t they said, “Come in-network. We have these options without high deductibles and copays. They take care of you after your inpatient stay, and many of you won’t even need inpatient care because we’ll have caught this early.” United actually has a platinum designation for providers that meet their criteria for excellence. But amazingly, no one knows it exists.
MH: Don’t providers share responsibility with insurers for developing a better system of comprehensive, coordinated care?
Kennedy: It’s not up to providers to show insurers all the ways of providing early intervention and comprehensive chronic-care management. I hear insurers complain all the time about shoddy residential treatment centers in Florida, and you get no argument from me about that. I want insurers to pay for every one of those beds until they figure out we don’t have to wait until patients are at stage 4 addiction before they get into treatment. It would save money and save families innumerable tragedies. Insurers have the power to create the behavioral healthcare model they want.
MH: How is the federal government doing under the 21st Century Cures Act mandate to coordinate federal efforts on behavioral health policy?
Kennedy: I have confidence in Dr. Elinore McCance-Katz (head of the Substance Abuse and Mental Health Services Administration). Her philosophy is we shouldn’t be fighting these diseases with grants that can run out halfway through the year. Rather, we should be treating these illnesses in the regular healthcare system, through insurance reimbursement and Medicaid expansion coverage. Hopefully she’ll lead SAMSHA out of its current existence.
MH: How do you see behavioral healthcare changing in the coming years?
Kennedy: The movement is on track to provide more transparency in how payers pay for care and how providers adhere to evidence-based protocols. The carrot is value-based purchasing where payers pay for quality. The stick is enforcement of the parity laws.