More people are seeking mental health services amid the pandemic, which will test the limits of the already-stretched sector and significantly increase healthcare costs if left unaddressed, a new report shows.
Around 12% of consumers with employer-based insurance sought help for mental health as a result of COVID-19, according to a new PricewaterhouseCoopers Health Research Institute survey from April 28 to May 8. An additional 18% reported plans for accessing mental healthcare as more people cope with loneliness, depression, less access to healthy food and fewer places to exercise, among other issues. The research is backed by other reports that reveal a spike in prescriptions for anti-anxiety medications, antidepressants and insomnia drugs.
Those who aren't seeking treatment said they can't afford it or don't know where to go. Around half of Americans who didn't get mental healthcare said they thought they could handle it own their own, while nearly a third couldn't afford it and more than a quarter didn't know where to go, according to HRI's survey from last year.
Those problems, in addition to a lack of qualified mental health clinicians, remain, said Benjamin Isgur, who leads the Health Research Institute.
"There are a lot of benefit plans with mental health services not being taken advantage of, some of which include carve outs for mental health visits that have no cost sharing," he said, adding that there needs to be better communication and continued reduction of the related stigma. "One of the challenges is access because mental health providers may not be in network. Mental health providers and payer networks have to figure out how to change that."
When people don't get care for their mental health issues, costs can increase by a multiple of 12, according to the report. Someone with a complex chronic condition and mental health illness costs employers 1.5 times more per year than someone with just a complex chronic disease alone and 12 times more than a healthy individual, HRI's analysis shows.
Researchers recommended leveraging the recent uptick in telehealth utilization to boost access to mental health services. Payers should waive cost sharing and expand their network of mental health providers. Providers should integrate virtual consultations with primary care and pharmaceutical manufacturers should partner with digital mental health companies to improve medication adherence, they said.
Providence's St. Joseph Hospital in Orange, Calif., for instance, has been facilitating discussions with its workers and the broader community on how to recognize stress and manage it through strategies like reflective listening, said Glenn Raup, executive director of behavioral health, emergency and observational health at St. Joseph.
"A second curve of this pandemic could be related to mental health," Raup previously told Modern Healthcare. "A post-wartime approach to how we think about things and process them is a big focus now and for the long term."
The Boston-based insurer Harvard Pilgrim Healthcare offers a phone-based therapy program through its behavioral healthcare vendor that's shown early promise for individuals with heart issues and anxiety, said Dan Rachfalski, chief actuary at Harvard Pilgrim.
"If someone with a heart conditions is experiencing chest pain, they will go to the ER and often will be admitted for observation," he told HRI. "If you can provide patients with tools to manage their anxiety, some of these ER visits and inpatient stays may be avoided."
While increased mental health utilization is not a bad thing, it is partly why medical costs are projected to increase between 4% to 10% next year, according to the report. The last several years have hovered around 6% increases, but this is the first year researchers offered a range given how differently COVID-19 is impacting different regions and how providers adjust prices accordingly. They may first lower prices to incentivize patients to return but could eventually raise prices to make up lost revenue and cover costs, researchers said.
Specialty drugs, which account for the majority of retail drug spending and make up an increasing share of the new drug pipeline, will also drive higher spending. Manufacturers are coming out with new uses for their products, exponentially increasing costs.
PwC's analysis of five cancer drugs revealed that cumulative revenues were less than $5 billion a year when they had 12 combined indications as of 2016. When the number of indications for those five drugs rose to 57 in 2020, sales surged to more than $15 billion.
"As specialty drugs, which were originally designed for a small population, get new indications, sales go up quite substantially," said Isgur, adding that most employers typically focus on new drugs rather than new indications for existing drugs. "We will have these costs for a while."